Breast Reconstruction Consultation Questionnaire
What a breast reconstruction consultation questionnaire asks, with sample questions on diagnosis, treatment, and reconstruction goals.
A breast reconstruction consultation questionnaire records the patient's diagnosis, cancer treatment, past breast and abdominal surgery, and reconstruction goals before seeing the plastic surgeon. The questions here are based on Atrium Health's breast reconstruction patient form and the reconstruction section of Kaiser Permanente's breast surgery worksheet.
Breast reconstruction consultation questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a breast reconstruction 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 reconstruction consultation questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- Was the diagnosis in the right or left breast?Diagnosis
- Have you tested positive for BRCA1 or BRCA2?Diagnosis
- Have you been treated with chemotherapy?Treatment
- Is radiation therapy planned or completed?Treatment
- What breast procedures have you had, and when?Past surgery
- What abdominal procedures have you had?Past surgery
- Why do you want breast reconstruction?Goals
- Would you prefer your own tissue or implants?Goals
- Have you seen another plastic surgeon about this?Care team
- Who is your oncologist?Care team
- Do you smoke?Smoking
- How long have you smoked?Smoking
These are examples to read, not a form to fill in.
Breast reconstruction consultation questionnaire: FAQ
What does a breast reconstruction consultation questionnaire ask?
The sample questions on this page are based on Atrium Health's breast reconstruction patient form and Kaiser Permanente's breast surgery worksheet. This page groups them into six areas: diagnosis, treatment, past surgery, goals, care team, and smoking.
Who fills in a breast reconstruction consultation questionnaire?
The patient. Atrium Health's form covers people thinking about or after a mastectomy or lumpectomy, people with a long-standing breast deformity, and people with implant problems.
Does it ask about cancer treatment?
The Atrium Health form asks about chemotherapy and radiation therapy. Kaiser Permanente's worksheet adds dates, planned treatment, and the names of the general surgeon, oncologist, and radiation therapist.
Does it ask about surgery outside the breast?
Yes. The Atrium Health form lists past abdomen procedures with dates, next to past breast procedures.
Is there a breast reconstruction consultation questionnaire template?
The sample questions on this page show a typical set. Atrium Health's two-page form is written in plain language and explains terms such as mastectomy and lumpectomy in brackets.
What happens after the form is completed?
The plastic surgeon reviews the answers before the exam. At Atrium Health, the patient form is followed by a separate exam sheet that the surgeon fills in.
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.
