Plastic Surgery New Patient Form
What a plastic surgery new patient form asks, with sample questions on medicines, allergies, past surgeries, and health history.
A plastic surgery new patient form records the reason for the consultation, medicines, allergies, past surgeries, and general health before a first plastic surgery visit. The questions here come from UCLA Health's plastic surgery new patient packet and UT Southwestern's cosmetic surgery clinic application.
Plastic surgery new patient form, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a plastic surgery new patient 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 plastic surgery new patient form questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- What is the reason for your consultation?Consultation
- Which procedures are you interested in?Consultation
- Which medicines do you take, and at what dose?Medications
- Do you take aspirin, ibuprofen, or fish oil?Medications
- Do you have any drug allergies?Allergies
- Are you allergic to bandages, tape, or adhesive?Allergies
- Which surgeries have you had, and who performed them?Past surgeries
- Have you had problems with anesthesia before?Past surgeries
- When was your most recent physical exam?Health history
- Do you bruise easily?Health history
- Do you smoke or use nicotine replacement?Lifestyle
- How much alcohol do you drink per week?Lifestyle
These are examples to read, not a form to fill in.
Plastic surgery new patient form: FAQ
What does a plastic surgery new patient form ask?
The sample questions on this page are based on UCLA Health's plastic surgery new patient packet and UT Southwestern's cosmetic surgery clinic application. This page groups them into six areas: consultation, medications, allergies, past surgeries, health history, and lifestyle.
Who fills in a plastic surgery new patient form, and when?
The patient, before the first consultation. The UCLA Health packet asks patients to arrive 15 minutes early for any extra paperwork and to bring a list of their medicines and supplements.
Does it ask about procedures the patient may want later?
Yes. The UT Southwestern application asks patients to mark the procedures they are interested in, including ones they may want in the future.
Does it ask about smoking?
Yes. The UCLA Health packet asks whether the patient never smoked, smokes now, or has quit, and about nicotine replacement such as a patch or gum.
Is there a plastic surgery new patient form template?
The sample questions on this page show a typical set. Each source adds its own sections, such as vision questions in the UCLA Health packet and questions for female patients in the UT Southwestern application.
What happens after the form is completed?
At the UT Southwestern resident cosmetic clinic, a clinic coordinator and a chief resident review new paperwork before a consultation is scheduled. AI Doctor only collects the answers for the practice's team.
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.
