Breast Implant Illness Questionnaire
What a breast implant illness questionnaire asks, with sample questions on implant details, symptoms, and earlier care.
A breast implant illness questionnaire records why and when a patient's implants were placed, the implant details, and the symptoms and diagnoses the patient reports. It's also called a breast implant history.
Breast implant illness questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a breast implant illness 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 implant illness questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- Why were your implants placed?Implant details
- Are your implants silicone, saline, or both?Implant details
- When were your implants placed?Past surgery
- Have you had earlier implant surgery?Past surgery
- Which symptoms have you had since your implants?Symptoms
- How long after placement did symptoms begin?Symptoms
- Have you been diagnosed with a thyroid condition?Diagnoses
- Did you have these diagnoses before your implants?Diagnoses
- Which other doctors have you seen for this?Earlier care
- Were any medicines or treatments prescribed?Earlier care
- Does anyone in your family have autoimmune disease?Other history
- Do you have any medication allergies?Other history
These are examples to read, not a form to fill in.
Breast implant illness questionnaire: FAQ
What does a breast implant illness questionnaire ask?
The sample questions on this page are based on The Aesthetic Society's Breast Implant Illness Patient questionnaire and a plastic surgery practice's version of it. This page groups them into six areas: implant details, past surgery, symptoms, diagnoses, earlier care, and other history.
Who answers a breast implant illness questionnaire?
The patient who has the implants. The Aesthetic Society lists the form on its breast implant resources page, next to a separate questionnaire for after implant removal.
Is it the same as a breast implant history?
It includes one. The Aesthetic Society form records why and when the implants were placed, the manufacturer, fill, shape, surface, and placement, then adds a symptom checklist.
Is there a breast implant illness questionnaire template?
The Aesthetic Society publishes one, dated September 2019. The sample questions on this page show a typical set drawn from it.
Does it ask about anything besides symptoms?
Yes. The Aesthetic Society form also asks about allergies to food, medicines, and the environment, tattoos, and major life changes since the implants were placed.
What happens after the form is completed?
The practice's team reviews the answers before the consultation. The questionnaire records what the patient reports; AI Doctor only collects the answers and does not judge their cause.
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.
