Hair Transplant Intake Form
What a hair transplant intake form asks, with sample questions on hair loss history, earlier treatment, and goals.
A hair transplant intake form records hair loss history, earlier treatment, health and surgical history, and the patient's goals before a hair transplant consultation. The sample questions on this page are built from form-builder templates and the American Board of Hair Restoration Surgery clinical history form.
Hair transplant intake form, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a hair transplant intake 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 hair transplant intake form questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- Which areas of your scalp are affected?Hair loss
- How long have you had hair loss?Hair loss
- Does hair loss run in your family?Family history
- Which relatives are affected, and in what pattern?Family history
- Which hair loss treatments have you tried?Previous treatment
- Have you had a hair transplant before?Previous treatment
- Do you have diabetes or a thyroid condition?Medical history
- Which medicines, vitamins, or supplements do you take?Medical history
- Have you had side effects from anesthesia?Surgical history
- Did past surgical wounds heal with keloid scars?Surgical history
- What do you expect from the treatment?Goals
- What else would you like the doctor to know?Goals
These are examples to read, not a form to fill in.
Hair transplant intake form: FAQ
What does a hair transplant intake form ask?
The sample questions on this page are built from two form-builder templates and the American Board of Hair Restoration Surgery clinical history form. This page groups them into six areas: hair loss, family history, previous treatment, medical history, surgical history, and goals.
Who fills in a hair transplant intake form?
The patient fills in the template forms before the consultation. The American Board of Hair Restoration Surgery form is different: the examining physician fills it in.
Does it ask about earlier hair loss treatment?
One template asks about minoxidil, finasteride or dutasteride, and PRP. The board's form lists PRP, light therapy, steroid injections, and stem cells.
Does it ask about past surgery?
Yes. The board's form records past surgeries with the type of anesthesia, any reported side effects, and how wounds healed, including raised or keloid scars.
Is there a hair transplant intake form template?
Form-builder companies publish hair transplant intake templates. The sample questions on this page show a typical set.
What happens after the form is completed?
The clinic's team reviews the answers before the consultation. AI Doctor only collects them; it does not judge whether a transplant is suitable.
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.
