Nicotine Declaration: Plastic Surgery
What a nicotine declaration plastic surgery form asks, with sample questions on smoking, vaping, and other nicotine.
A nicotine declaration plastic surgery form records the patient's own report of smoking, vaping, other nicotine products, and marijuana use before plastic surgery. The questions on this page are built from an American Society of Plastic Surgeons practice reference and a Halton Healthcare (Canada) pre-operative questionnaire.
Nicotine declaration plastic surgery form, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a nicotine declaration for plastic surgery 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 questions on a nicotine declaration for plastic surgery
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- Do you smoke cigarettes or cigars now?Cigarettes
- How many per day, and for how many years?Cigarettes
- Did you smoke or vape in the past?Past use
- How long ago did you quit?Past use
- Do you use e-cigarettes or vape?Vaping
- How many times per day do you vape?Vaping
- Do you use nicotine patches or lozenges?Other nicotine
- Do you use chewing tobacco?Other nicotine
- Do you smoke or vape marijuana?Marijuana
- Do you consume marijuana in other forms?Marijuana
- Does anyone in your household smoke?Other factors
- Do you have COPD or a chronic cough?Other factors
These are examples to read, not a form to fill in.
Nicotine declaration plastic surgery form: FAQ
What does a nicotine declaration plastic surgery form ask?
The sample questions on this page are based on an American Society of Plastic Surgeons (ASPS) practice reference and a Halton Healthcare (Canada) pre-operative questionnaire. This page groups them into six areas: cigarettes, past use, vaping, other nicotine, marijuana, and other factors.
Who fills in a nicotine declaration plastic surgery form, and when?
The patient, before plastic surgery. The ASPS practice reference also suggests asking about cigarette and other nicotine use again at follow-up visits after surgery.
Why does the practice ask about nicotine?
The ASPS practice reference names smoking as a risk factor for problems after surgery. It suggests documenting the patient's answers to screening questions.
Is it the same as a cotinine test consent?
No. The ASPS practice reference says a surgeon may consider a separate urine cotinine or nicotine test; this form records only what the patient reports.
Does it ask about marijuana?
The ASPS practice reference suggests considering it, and the Halton Healthcare questionnaire asks about smoking or vaping marijuana. AI Doctor records the answer without judgment.
What happens after the form is completed?
The surgical team reviews the answers. AI Doctor gives no advice on stopping nicotine or on timing.
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.
