Breast Augmentation Consultation Questionnaire
What a breast augmentation consultation questionnaire asks, with sample questions on goals, breast size, and health history.
A breast augmentation consultation questionnaire records the patient's goals, current and desired breast size, breast history, medicines, and habits before the consultation. The questions on this page come from Kaiser Permanente's breast surgery patient worksheet and the consultation topics listed by the American Society of Plastic Surgeons.
Breast augmentation consultation questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a breast augmentation consultation 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 breast augmentation consultation questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- What is your main concern about your breasts?Goals
- What questions would you like answered?Goals
- What is your current bra size?Breast size
- What cup size would you like?Breast size
- When was your last mammogram?Breast history
- Have you had any breast surgery before?Breast history
- What medical problems do you have?Health history
- Do you form keloids or thick scars?Health history
- Which medicines do you take, and how often?Medicines
- Do you take vitamins or herbal medicines?Medicines
- Do you use tobacco?Habits
- Do you drink alcohol?Habits
These are examples to read, not a form to fill in.
Breast augmentation consultation questionnaire: FAQ
What does a breast augmentation consultation questionnaire ask?
The sample questions on this page are based on Kaiser Permanente's breast surgery worksheet and the consultation topics of the American Society of Plastic Surgeons (ASPS). This page groups them into six areas: goals, breast size, breast history, health history, medicines, and habits.
Who fills in a breast augmentation consultation questionnaire?
The patient, before the consultation. ASPS lists the topics to be ready to discuss: goals and expectations, medical conditions, allergies, past treatments, medicines, supplements, alcohol, tobacco, and drug use.
Does it ask about bra and cup size?
Yes. Kaiser Permanente's worksheet has a breast size table: bra size, plus current, largest, smallest, and desired cup size for each breast.
Is there a breast augmentation consultation questionnaire template?
The sample questions on this page show a typical set. Kaiser Permanente's worksheet covers several breast procedures, not augmentation alone.
Does it ask about mammograms?
ASPS lists family history of breast cancer and the results of any mammograms or biopsies among the consultation topics. The Kaiser Permanente worksheet asks for the date and result of the last mammogram.
What happens after the form is completed?
The surgeon reads the answers before the exam. ASPS says the surgeon then examines and measures the breasts, takes photographs, and talks through the options.
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.
