Bariatric Nutrition Evaluation Form
What a bariatric nutrition evaluation form asks, with sample questions on weight history, meals, drinks, and activity.
A bariatric nutrition evaluation form records weight history, past diets, meal and drinking habits, and activity before a dietitian visit for weight loss surgery. The questions on this page are based on forms from Hunterdon Health, Lakewood Health System, and the University of Iowa Hospitals & Clinics.
Bariatric nutrition evaluation form, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a bariatric nutrition evaluation form in the patient's own language, strictly following the practice's instructions.
- Intake before the visit. Patients answer online before they arrive, or at a kiosk when they check in.
- Answers ready for the clinician. Clinicians see what the patient said before the visit starts.
- Less workload at the front desk. Staff spend less time handing out forms and entering answers by hand.
- Key details at a glance. The care team sees what matters up front and decides who needs attention first.
The form becomes a natural conversation: patients answer by talking, in their own words. AI Doctor is an information and patient-assistance interface. It collects answers for the care team to review. It doesn't diagnose, triage, or give treatment advice.
Sample bariatric nutrition evaluation form questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- What is your highest adult weight?Weight history
- How would you describe your weight as a child?Weight history
- Which diet programs have you tried before?Diet history
- Have you had nutrition education before?Diet history
- Who prepares your meals at home?Meals
- How often do you eat away from home?Meals
- Do you often skip meals?Eating habits
- At what time of day do you eat most?Eating habits
- How much water do you drink a day?Drinks
- What are your main drinks during the day?Drinks
- Are you exercising right now?Activity
- What gets in the way of exercising?Activity
These are examples to read, not a form to fill in.
Bariatric nutrition evaluation form: FAQ
What does a bariatric nutrition evaluation form ask?
The sample questions on this page are based on forms from Hunterdon Health, Lakewood Health System, and the University of Iowa Hospitals & Clinics. This page groups them into six areas: weight history, diet history, meals, eating habits, drinks, and activity.
Who fills in a bariatric nutrition evaluation form?
The patient. Hunterdon Health asks patients to complete its form in pen and bring it to the nutrition appointment.
Does it ask about past diets?
Yes. Hunterdon Health asks for a brief history of weight loss attempts, and the Iowa form asks for each diet's dates, starting weight, and pounds lost or gained.
Does it include a food record?
Yes. The Hunterdon Health form ends with a one-day record of breakfast, lunch, dinner, and snacks, with times, foods, and amounts.
Is there a bariatric nutrition evaluation form template?
The sample questions on this page show a typical set, drawn from three hospital program forms.
Does the avatar give diet advice?
No. AI Doctor only collects the answers, and the program's team decides what to discuss.
Does AI Doctor give medical advice?
No. It collects information for the care team. It doesn't diagnose, triage, or recommend treatment.
Can patient answers stay on our own servers?
Yes. RAVATAR offers on-prem deployment: the platform can run inside your own perimeter, so patient answers stay there. RAVATAR complies with GDPR and the EU AI Act.
Set up your AI Doctor in Genesis AI Avatar Studio
Genesis AI Avatar Studio is where you set up, test, and publish AI avatars for your website, mobile app, or Holobox. No coding or technical skills needed.
- 01Choose the AI Doctor avatar.
- 02Add your practice's FAQs and visit information.
- 03Talk to it, then publish it.
