Vascular Surgery New Patient Questionnaire
What a vascular surgery new patient questionnaire asks, with sample questions on risk factors, activity, and tobacco.
A vascular surgery new patient questionnaire records risk factors, activity, tobacco use, allergies, and family and medical history before a first vascular consultation. The sample questions on this page are based on the new vascular consult questionnaire of Allina Health's Minneapolis Heart Institute.
Vascular surgery new patient questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a vascular surgery new patient 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 vascular surgery new patient questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- Have you been treated for high blood pressure?Risk factors
- Have you ever had high cholesterol?Risk factors
- Do you exercise regularly?Activity
- How far can you walk before symptoms begin?Activity
- Do you smoke, or did you smoke before?Tobacco
- What year did you stop smoking?Tobacco
- Have you had contrast dye for an X-ray?Allergies
- Did the contrast dye cause any side effects?Allergies
- Has a relative had an abdominal aortic aneurysm?Family history
- Has a relative had leg artery bypass surgery?Family history
- Have you ever had diabetes?Medical history
- Have you ever had a blood transfusion?Medical history
These are examples to read, not a form to fill in.
Vascular surgery new patient questionnaire: FAQ
What does a vascular surgery new patient questionnaire ask?
The sample questions on this page are based on the Allina Health Minneapolis Heart Institute new vascular consult questionnaire. This page groups them into six areas: risk factors, activity, tobacco, allergies, family history, and medical history.
Who completes a vascular surgery new patient questionnaire?
The patient, before the vascular consultation. The form opens with the primary physician, the referring physician, and the reason for the visit.
Does it ask about contrast dye?
It asks whether the patient has had contrast dye for an X-ray or test and any side effects. It also asks what caused any hives, such as iodine or shellfish.
Which family history does it ask about?
Vascular and heart disease in close relatives, including stroke, abdominal aortic aneurysm, leg artery bypass or stents, leg amputation, and heart attack.
Is there a vascular surgery new patient questionnaire template?
The sample questions on this page show a typical set. The Minneapolis Heart Institute form also asks about stress, caffeine, education, and how the patient prefers to learn.
What happens after the questionnaire is completed?
The vascular team reviews the answers before the visit. AI Doctor only records them; it does not check symptoms or decide what care is needed.
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.
