Hernia Surgery Intake Questionnaire
What a hernia surgery intake questionnaire asks, with sample questions on hernia details, past repairs, and anesthesia.
A hernia surgery intake questionnaire records the hernia to be repaired, past repairs, health and anesthesia history, and lifestyle before a hernia surgery visit. It's also called a hernia health history questionnaire.
Hernia surgery intake questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a hernia surgery intake 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 hernia surgery intake questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- Who referred you to the hernia center?Referral
- How did you hear about us?Referral
- Which hernia would you like repaired?Hernia details
- How was the hernia diagnosed?Hernia details
- Have you had hernia surgery before?Past repairs
- Was mesh placed during a past hernia repair?Past repairs
- Do you have diabetes or abnormal blood sugar?Medical history
- Which prescription and over-the-counter drugs do you take?Medical history
- Have you had a reaction to anesthesia?Anesthesia history
- Has a relative had an anesthesia reaction?Anesthesia history
- Do you smoke or use tobacco?Lifestyle
- How many alcoholic drinks do you have weekly?Lifestyle
These are examples to read, not a form to fill in.
Hernia surgery intake questionnaire: FAQ
What does a hernia surgery intake questionnaire ask?
The sample questions on this page are based on the Stony Brook Medicine Hernia Center questionnaire and UCLA Health's surgery intake form for hernia care. This page groups them into six areas: referral, hernia details, past repairs, medical history, anesthesia history, and lifestyle.
Who fills in a hernia surgery intake questionnaire, and when?
The patient, before the visit. UCLA Health asks patients to fill out its surgery intake form and bring it along, and the Stony Brook form can be faxed ahead.
Is it the same as a hernia health history questionnaire?
It can be. Stony Brook Medicine titles its version Hernia Center Health History Questionnaire, and it covers the same hernia and health history.
Can the questionnaire replace an exam?
No. The Stony Brook form says an in-person physical examination at the clinic is still required for a final diagnosis and a treatment plan.
Is there a hernia surgery intake questionnaire template?
The sample questions on this page show a typical set. The Stony Brook form also asks the type, side, and approximate size of each hernia.
What happens after the form is completed?
The surgical team reviews the answers before the visit. AI Doctor only records them; it never tells a patient whether they have a hernia.
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.
