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Disabilities of the Arm Shoulder and Hand
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Use our readymade template to create your Disabilities of the Arm, Shoulder and Hand (DASH) assessment tool

Create your care assessments

DASH score Severity Proposed treatment
0-20 Mild Conservative management
21-40 Moderate Physical therapy
41-60 Severe Surgical intervention
61-80 Very severe Surgical intervention
81-100 Extremely severe Surgical intervention
  • navigate_next Prebuilt template with DASH scoring to assess the presence of upper limb disorders and measure its severity
  • navigate_next 30-item questionnaire that scores each item based on the patient's ability to perform certain activities and the severity of symptoms
  • navigate_next Real-time calculation of DASH Score based on the form responses
  • navigate_next Collect patient data and other sensitive healthcare data using our HIPAA compliant online assessment forms
  • navigate_next Compare the scores from the initial screening with that of the followup to track the progression of upper limb disorders
  • navigate_next 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
Doctor's Name Dr. Smith
Location New York
1. Open a tight or new jar. Mild difficulty
2. Write. No difficulty
3. Turn a key. Moderate difficulty
4. Prepare a meal. Severe difficulty
5. Push open a heavy door. Unable
6. Place an object on a shelf above your head. No difficulty
7. Do heavy household chores (e.g., wash walls, wash floors). Mild difficulty
8. Garden or do yard work. Moderate difficulty
9. Make a bed. Severe difficulty
10. Carry a shopping bag or briefcase. Unable
11. Carry a heavy object (over 10 lbs). No difficulty
12. Change a lightbulb overhead. Mild difficulty
13. Wash or blow dry your hair. Moderate difficulty
14. Wash your back. Severe difficulty
15. Put on a pullover sweater. Unable
16. Use a knife to cut food. No difficulty
17. Recreational activities which require little effort (e.g., card playing, knitting, etc.). Mild difficulty
18. Recreational activities in which you take some force or impact through your arm, shoulder or hand (e.g., golf, hammering, tennis, etc.). Moderate difficulty
19. Recreational activities in which you move your arm freely (e.g., playing frisbee, badminton, etc.). Severe difficulty
20. Manage transportation needs (getting from one place to another). Unable
21. Sexual activities. No difficulty
22. During the past week, to what extent has your arm, shoulder or hand problem interfered with your normal social activities with family, friends, neighbours or groups? Slightly
23. During the past week, were you limited in your work or other regular daily activities as a result of your arm, shoulder or hand problem? Moderately limited
24. Arm, shoulder or hand pain. Severe
25. Arm, shoulder or hand pain when you performed any specific activity. Extreme
26. Tingling (pins and needles) in your arm, shoulder or hand. None
27. Weakness in your arm, shoulder or hand. Mild
28. Stiffness in your arm, shoulder or hand. Moderate
29. During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder or hand? Severe difficulty
30. I feel less capable, less confident or less useful because of my arm, shoulder or hand problem. Agree
DASH score 45
  • navigate_next Pre-populate patient details such as patient id, name, email etc in the DASH assessment form before sharing it with the patients
  • navigate_next Send an email invitation with a secure link for patients to complete their DASH assessment form prior to their visit
  • navigate_next Allow patients to save their progress and complete their DASH assessment form at a later time without losing any responses
  • navigate_next Set up an email template for your DASH assessment and automatically send invitation emails to multiple patients with ease
  • navigate_next Send a confirmation email to the patients with their DASH score, diagnosis, next steps when they submit their DASH assessment

Track patient responses in Google Sheets

A B C D E
1 Name Question Answer Score Total Score
2 John W 1. Open a tight or new jar. Mild difficulty 2 45
3 John W 2. Write. No difficulty 1 45
4 John W 3. Turn a key. Moderate difficulty 3 45
5 John W 4. Prepare a meal. Severe difficulty 4 45
6 John W 5. Push open a heavy door. Unable 5 45
7 John W 6. Place an object on a shelf above your head. No difficulty 1 45
8 John W 7. Do heavy household chores (e.g., wash walls, wash floors). Mild difficulty 2 45
9 John W 8. Garden or do yard work. Moderate difficulty 3 45
10 John W 9. Make a bed. Severe difficulty 4 45
11 John W 10. Carry a shopping bag or briefcase. Unable 5 45
12 John W 11. Carry a heavy object (over 10 lbs). No difficulty 1 45
13 John W 12. Change a lightbulb overhead. Mild difficulty 2 45
14 John W 13. Wash or blow dry your hair. Moderate difficulty 3 45
15 John W 14. Wash your back. Severe difficulty 4 45
16 John W 15. Put on a pullover sweater. Unable 5 45
17 John W 16. Use a knife to cut food. No difficulty 1 45
18 John W 17. Recreational activities which require little effort (e.g., card playing, knitting, etc.). Mild difficulty 2 45
19 John W 18. Recreational activities in which you take some force or impact through your arm, shoulder or hand (e.g., golf, hammering, tennis, etc.). Moderate difficulty 3 45
20 John W 19. Recreational activities in which you move your arm freely (e.g., playing frisbee, badminton, etc.). Severe difficulty 4 45
21 John W 20. Manage transportation needs (getting from one place to another). Unable 5 45
22 John W 21. Sexual activities. No difficulty 1 45
23 John W 22. During the past week, to what extent has your arm, shoulder or hand problem interfered with your normal social activities with family, friends, neighbours or groups? Slightly 2 45
24 John W 23. During the past week, were you limited in your work or other regular daily activities as a result of your arm, shoulder or hand problem? Moderately limited 3 45
25 John W 24. Arm, shoulder or hand pain. Severe 4 45
26 John W 25. Arm, shoulder or hand pain when you performed any specific activity. Extreme 5 45
27 John W 26. Tingling (pins and needles) in your arm, shoulder or hand. None 1 45
28 John W 27. Weakness in your arm, shoulder or hand. Mild 2 45
29 John W 28. Stiffness in your arm, shoulder or hand. Moderate 3 45
30 John W 29. During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder or hand? Severe difficulty 4 45
31 John W 30. I feel less capable, less confident or less useful because of my arm, shoulder or hand problem. Agree 4 45
  • navigate_next Export patient responses including the calculated DASH score to Google Sheets for easy record-keeping
  • navigate_next Export individual points for each item to Google Sheets for data manipulation and analysis for comprehensive insights
  • navigate_next Use pre-built reports to easily keep track of patient progress over time and monitor changes in their upper limb function
  • navigate_next Receive a copy of the response and the calculated DASH score by email whenever a patient submits their DASH assessment
  • navigate_next 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: ******
Doctor's Name: Dr. Smith
Location: New York
1. Open a tight or new jar.: Mild difficulty
2. Write.: No difficulty
3. Turn a key.: Moderate difficulty
4. Prepare a meal.: Severe difficulty
5. Push open a heavy door.: Unable
6. Place an object on a shelf above your head.: No difficulty
7. Do heavy household chores (e.g., wash walls, wash floors).: Mild difficulty
8. Garden or do yard work.: Moderate difficulty
9. Make a bed.: Severe difficulty
10. Carry a shopping bag or briefcase.: Unable
11. Carry a heavy object (over 10 lbs).: No difficulty
12. Change a lightbulb overhead.: Mild difficulty
13. Wash or blow dry your hair.: Moderate difficulty
14. Wash your back.: Severe difficulty
15. Put on a pullover sweater.: Unable
16. Use a knife to cut food.: No difficulty
17. Recreational activities which require little effort (e.g., card playing, knitting, etc.).: Mild difficulty
18. Recreational activities in which you take some force or impact through your arm, shoulder or hand (e.g., golf, hammering, tennis, etc.).: Moderate difficulty
19. Recreational activities in which you move your arm freely (e.g., playing frisbee, badminton, etc.).: Severe difficulty
20. Manage transportation needs (getting from one place to another).: Unable
21. Sexual activities.: No difficulty
22. During the past week, to what extent has your arm, shoulder or hand problem interfered with your normal social activities with family, friends, neighbours or groups?: Slightly
23. During the past week, were you limited in your work or other regular daily activities as a result of your arm, shoulder or hand problem?: Moderately limited
24. Arm, shoulder or hand pain.: Severe
25. Arm, shoulder or hand pain when you performed any specific activity.: Extreme
26. Tingling (pins and needles) in your arm, shoulder or hand.: None
27. Weakness in your arm, shoulder or hand.: Mild
28. Stiffness in your arm, shoulder or hand.: Moderate
29. During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder or hand?: Severe difficulty
30. I feel less capable, less confident or less useful because of my arm, shoulder or hand problem. : Agree
DASH score: 45
DASH score: 45
  • navigate_next Create a HIPAA compliant DASH assessment form to safely collect, store and access patient responses
  • navigate_next Mark fields as Protected Health Information (PHI) to secure sensitive patient data and limit access to PHI
  • navigate_next Automatically mask PHI fields when exporting DASH form responses to Google Sheets and sending them on email
  • navigate_next Prepopulate patient details in DASH assessments by creating secure prefill links without exposing PHI
  • navigate_next 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.

July 23, 2023

5 stars

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

October 31, 2023

5 stars

We needed a way to create forms with e-signatures and this app made it very easy. Support is also very quick and always helpful. Cannot recommend enough!

— Chris Henesy

February 16, 2024

1 stars

Does not work

— Myles Sicuro

July 12, 2023

5 stars

It very friendly to used. I love it. For my case multiple signature needed. it's supporting

— Senthil Kumar

November 27, 2023

5 stars

Yeah this is good for all

— luqman Khan

July 10, 2023

5 stars

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

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Upper limb Care assessments
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