Bariatric Surgery Questionnaire
What a bariatric surgery questionnaire asks, with sample questions on weight history, health conditions, and past surgery.
A bariatric surgery questionnaire records the procedure of interest, weight history, health conditions, past surgery, and social history before a weight loss surgery program visit. It's also called a surgical weight loss intake or a bariatric patient intake questionnaire.
Bariatric surgery questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a bariatric surgery questionnaire 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 surgery questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- Which procedure are you interested in?Procedure
- Have you had bariatric surgery before?Procedure
- How old were you when weight became a struggle?Weight history
- What did you weigh at age 18?Weight history
- Have you been diagnosed with sleep apnea?Health history
- Do you have reflux or heartburn?Health history
- Which operations have you had, laparoscopic or open?Surgical history
- Have you had problems with anesthesia before?Surgical history
- Are you currently employed?Social history
- Do you use tobacco or nicotine products?Social history
- Were you referred by a doctor or yourself?Referral
- Who is your primary care physician?Referral
These are examples to read, not a form to fill in.
Bariatric surgery questionnaire: FAQ
What does a bariatric surgery questionnaire ask?
The sample questions on this page are based on questionnaires from Lahey Hospital & Medical Center's Surgical Weight Loss Center and University of Iowa Hospitals & Clinics. This page groups them into six areas: procedure, weight history, health history, surgical history, social history, and referral.
Who fills in a bariatric surgery questionnaire?
The patient. The Iowa form asks patients to complete and return it before an evaluation can be considered.
Is it the same as a bariatric patient intake questionnaire?
It can be. Lahey's version is a new patient questionnaire for its Surgical Weight Loss Center, and it covers the same intake history.
Does it ask about revision surgery?
Yes. The Iowa form asks whether the patient has had bariatric surgery before, when, where, which type, and the reasons for seeking a revision.
Does it ask about sleep?
Yes. The Iowa form asks about sleep apnea, a sleep study, daytime sleepiness, and snoring; the samples here ask only about a sleep apnea diagnosis.
What happens after the bariatric surgery questionnaire is returned?
The program's team reviews the answers before an evaluation. AI Doctor only collects them; it does not decide whether surgery fits the patient.
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.
