Dermal Filler Consultation Form
What a dermal filler consultation form asks, with sample questions on past fillers, allergies, and medicines.
A dermal filler consultation form records areas of concern, past fillers, health history, allergies, medicines, and pregnancy before filler injections. The questions here come from the history forms of a medical spa, a facial plastic surgery practice, and a plastic surgery practice.
Dermal filler consultation form, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a dermal filler consultation 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 dermal filler consultation form questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- Which skin concerns would you like to discuss?Concerns
- Are thin lips or facial wrinkles a concern?Concerns
- Which injections or fillers have you had?Past fillers
- When was your last filler treatment?Past fillers
- Are you under a physician's care now?Health history
- Do you get frequent cold sores?Health history
- Have you reacted to lidocaine or numbing medicine?Allergies
- Do you have any drug allergies?Allergies
- Do you take aspirin, ibuprofen, or blood thinners?Medications
- Which herbal supplements do you use regularly?Medications
- Are you pregnant or trying to become pregnant?Pregnancy
- Are you breastfeeding?Pregnancy
These are examples to read, not a form to fill in.
Dermal filler consultation form: FAQ
What does a dermal filler consultation form ask?
The sample questions on this page are based on history forms from a medical spa, a facial plastic surgery practice, and a plastic surgery practice. This page groups them into six areas: concerns, past fillers, health history, allergies, medications, and pregnancy.
Who fills in a dermal filler consultation form?
The patient, before the consultation. The medical spa's and the facial plastic surgery practice's forms end with the patient certifying that the answers are true and correct.
Does it ask about past fillers?
Yes. The facial plastic surgery practice's form asks which injections or fillers the patient has had and the date of the last treatment.
Does it ask about allergies and medicines?
Yes. The facial plastic surgery practice's form asks about reactions to lidocaine, and the medical spa's form asks about aspirin, ibuprofen, warfarin, and other blood thinners.
Is there a dermal filler consultation form template?
The sample questions on this page show a typical set. They come from general cosmetic history forms, not from a dedicated filler questionnaire.
What happens after the form is completed?
The practice's team reviews the answers before any filler is planned. AI Doctor only collects them; it does not choose a product or a treatment area.
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.
