Use our readymade template to create your Mood Disorder Questionnaire (MDQ) for screening bipolar disorder
Create your care assessments
| MDQ score | Bipolar Disorder |
|---|---|
| 7 or more | Positive screen |
- Prebuilt template with MDQ scoring to assess the presence of bipolar disorder
- 13-item questionnaire that scores each item as “0” (No) to “1” (Yes)
- Real-time calculation of MDQ Score and bipolar disorder based on the form responses
- Collect patient data and other sensitive healthcare data using our HIPAA compliant online assessment forms
- Easily create responsive forms that allow patients to complete their assessments on any device at any time
Collect responses from your patients
| Patient ID | 1004 |
| Patient Name | John W |
| Patient Email | johnw@ymail.com |
| Patient Phone Number | 0987654321 |
| 1. Has there ever been a period of time when you were not your usual self and… | |
| 2. If you checked YES to more than one of the above, have several of these ever happened during the same period of time? | Yes |
| 3. How much of a problem did any of these cause you — like being able to work; having family, money, or legal troubles; getting into arguments or fights? | Serious problem |
| MDQ Score | 8 |
| Bipolar Disorder | Positive screen |
- Pre-populate patient details such as patient id, name, email etc in the MDQ assessment form before sharing it with the patients
- Send an email invitation with a secure link for patients to complete their MDQ assessment form prior to their visit
- Allow patients to save their progress and complete their MDQ assessment form at a later time without losing any responses
- Set up an email template for your MDQ assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their MDQ score, diagnosis, next steps when they submit their MDQ assessment
Track patient responses in Google Sheets
| A | B | C | D | E | |
|---|---|---|---|---|---|
| 1 | Name | Question | Answer | Score | Total Score |
| 2 | John W | 2. If you checked YES to more than one of the above, have several of these ever happened during the same period of time? | Yes | 1 | 8 |
| 3 | John W | 3. How much of a problem did any of these cause you — like being able to work; having family, money, or legal troubles; getting into arguments or fights? | Serious problem | 1 | 8 |
- Export patient responses including the calculated MDQ score and bipolar disorder to Google Sheets for easy record-keeping
- Export individual points for 13 items to Google Sheets for data manipulation and analysis for comprehensive insights
- Use pre-built reports to easily keep track of patient progress over time and monitor changes in their bipolar symptoms
- Receive a copy of the response and the calculated MDQ score by email whenever a patient submits their MDQ assessment
- Use data in Google Sheets to integrate with external EHR systems for seamless data transfer
HIPAA compliance
| Patient ID: | 1004 |
| Patient Name: | ****** |
| Patient Email: | ****** |
| Patient Phone Number: | ****** |
| 2. If you checked YES to more than one of the above, have several of these ever happened during the same period of time?: | Yes |
| 3. How much of a problem did any of these cause you — like being able to work; having family, money, or legal troubles; getting into arguments or fights?: | Serious problem |
| MDQ Score: | 8 |
| Bipolar Disorder: | Positive screen |
| MDQ Score: | 8 |
| Bipolar Disorder: | Positive screen |
- Create a HIPAA compliant MDQ assessment form to safely collect, store and access patient responses
- Mark fields as Protected Health Information (PHI) to secure sensitive patient data and limit access to PHI
- Automatically mask PHI fields when exporting MDQ form responses to Google Sheets and sending them on email
- Prepopulate patient details in MDQ assessments by creating secure prefill links without exposing PHI
- Limit access to patient data only for authorized personnel and minimize the risk of data breaches
These reviews are reproduced without modification from Google Workspace Marketplace.
May 30, 2025
Besides the fact that one gets billed $216 monthly, Support took a long time to try and get things to work. Trying to get things signed on a form was such an issue and through out formatting. Way over priced, support that you have to wait till the next day to get one thing sorted and not sorted, back and forth the whole time. Frustrating customers and damage to business. I will not reccommend this company to anyone. Try JotForms so much better, and you can do much more for a fraction of the cost per year not per month.
— Francois Ohsiek
June 3, 2025
Hi Francois, sorry you had a frustrating experience with the formatting. Just to clarify, the plan you’re on is $216 per year, not per month. You signed up for the Formesign Esignature paid plan on May 8, 2024, and since you also needed to sign agreements, we provided access to our Formesign - Fillable PDF add-on at no extra cost. Regarding formatting: when working with Google Docs templates, we recommend using lists instead of indents and setting up layouts with tables for images, rather than inserting images directly. This helps maintain proper formatting. To assist, we also created and shared a sample template as a reference. You had asked us to make edits on your behalf, which we’re not able to do for security reasons. However, we did reach out and invited you to join a scheduled Zoom call to walk through the process — as we’ve done several times over the past year — but we didn’t receive a response. Update: To make things easier for all users, we have just launched the new document editor in Formesign that will allow agreements to be created directly, without relying on Google Docs.
— Formfacade
July 23, 2023
I am not tech savvy. I chose formesign to help create registration links for clients. Vipid has been great in assisting me. He goes above and beyond. My company now has moved from the stone age to modern age through the ability to use this feature. Of the many features I am impressed with, the ability to update a form without needing to regenerate a link is amazing. I often make mistakes and that ability allows me to fix mistakes without needing to change everything. Thank you!!!
— Sol Evans
July 12, 2023
It very friendly to used. I love it. For my case multiple signature needed. it's supporting
— Senthil Kumar
February 16, 2024
Does not work
— Myles Sicuro
November 27, 2023
Yeah this is good for all
— luqman Khan
July 10, 2023
We were looking for a way to have a signature option in our form. Formesign addon allowed us to collect signatures for the acknowledgment and consent forms. It was simple and easy to setup. Very useful addon for google forms.
— Joan S