Use our readymade template to create your Foot and Ankle Disability Index (FADI) assessment tool
Create your care assessments
- Prebuilt template with FADI scoring to assess the presence and severity of foot and ankle conditions
- 26-item questionnaire that scores each item based on the level of difficulty or pain experienced by the patient
- Real-time calculation of FADI Score based on the form responses
- Collect patient data and other sensitive healthcare data using our HIPAA compliant online assessment forms
- Compare the scores from the initial screening with that of the followup to track the progression of the condition
- 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 |
Select the difficult level for each activity | |
1. Standing | None at all |
2. Walking on even ground | Slight |
3. Walking on even ground without shoes | Moderate |
4. Walking up hills | Extreme |
5. Walking down hills | Unable |
6. Going up stairs | None at all |
7. Going down stairs | Slight |
8. Walking on uneven ground | Moderate |
9. Stepping up and down curves | Extreme |
10. Squatting | Unable |
11. Sleeping | None at all |
12. Coming up to your toes | Slight |
13. Walking initially | Moderate |
14. Walking 5 minutes or less | Extreme |
15. Walking approximately 10 minutes | Unable |
16. Walking 15 minutes or greater | None at all |
17. Home responsibilities | Slight |
18. Activities of daily living | Moderate |
19. Personal care | Extreme |
20. Light to moderate work (standing, walking) | Unable |
21. Heavy work (push/pulling, climbing, carrying) | None at all |
22. Recreational activities | Slight |
Select the level of pain | |
23. General level of pain | Moderate |
24. Pain at rest | Extreme |
25. Pain during your normal activity | Unable |
26. Pain first thing in the morning | None at all |
FADI Score (in %) | 75 |
- Collect patient details such as patient id, name, email etc in the FADI assessment form
- Send an email invitation with a secure link for patients to complete their FADI assessment form prior to their visit
- Allow patients to save their progress and complete their FADI assessment form at a later time without losing any responses
- Set up an email template for your FADI assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their FADI score, diagnosis, next steps when they submit their FADI assessment
Track patient responses in Google Sheets
A | B | C | D | E | |
---|---|---|---|---|---|
1 | Name | Question | Answer | Score | Total Score |
2 | John W | 1. Standing | None at all | 4 | 75 |
3 | John W | 2. Walking on even ground | Slight | 3 | 75 |
4 | John W | 3. Walking on even ground without shoes | Moderate | 2 | 75 |
5 | John W | 4. Walking up hills | Extreme | 1 | 75 |
6 | John W | 5. Walking down hills | Unable | 0 | 75 |
7 | John W | 6. Going up stairs | None at all | 4 | 75 |
8 | John W | 7. Going down stairs | Slight | 3 | 75 |
9 | John W | 8. Walking on uneven ground | Moderate | 2 | 75 |
10 | John W | 9. Stepping up and down curves | Extreme | 1 | 75 |
11 | John W | 10. Squatting | Unable | 0 | 75 |
12 | John W | 11. Sleeping | None at all | 4 | 75 |
13 | John W | 12. Coming up to your toes | Slight | 3 | 75 |
14 | John W | 13. Walking initially | Moderate | 2 | 75 |
15 | John W | 14. Walking 5 minutes or less | Extreme | 1 | 75 |
16 | John W | 15. Walking approximately 10 minutes | Unable | 0 | 75 |
17 | John W | 16. Walking 15 minutes or greater | None at all | 4 | 75 |
18 | John W | 17. Home responsibilities | Slight | 3 | 75 |
19 | John W | 18. Activities of daily living | Moderate | 2 | 75 |
20 | John W | 19. Personal care | Extreme | 1 | 75 |
21 | John W | 20. Light to moderate work (standing, walking) | Unable | 0 | 75 |
22 | John W | 21. Heavy work (push/pulling, climbing, carrying) | None at all | 4 | 75 |
23 | John W | 22. Recreational activities | Slight | 3 | 75 |
24 | John W | 23. General level of pain | Moderate | 2 | 75 |
25 | John W | 24. Pain at rest | Extreme | 75 | |
26 | John W | 25. Pain during your normal activity | Unable | 75 | |
27 | John W | 26. Pain first thing in the morning | None at all | 75 |
- Export patient responses including the calculated FADI score to Google Sheets for easy record-keeping
- Export individual points for each item 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 foot and ankle conditions
- Receive a copy of the response and the calculated FADI score by email whenever a patient submits their FADI 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: | ****** |
Doctor's Name: | Dr. Smith |
Location: | New York |
Select the difficult level for each activity | |
1. Standing: | None at all |
2. Walking on even ground: | Slight |
3. Walking on even ground without shoes: | Moderate |
4. Walking up hills: | Extreme |
5. Walking down hills: | Unable |
6. Going up stairs: | None at all |
7. Going down stairs: | Slight |
8. Walking on uneven ground: | Moderate |
9. Stepping up and down curves: | Extreme |
10. Squatting: | Unable |
11. Sleeping: | None at all |
12. Coming up to your toes: | Slight |
13. Walking initially: | Moderate |
14. Walking 5 minutes or less: | Extreme |
15. Walking approximately 10 minutes: | Unable |
16. Walking 15 minutes or greater: | None at all |
17. Home responsibilities: | Slight |
18. Activities of daily living: | Moderate |
19. Personal care: | Extreme |
20. Light to moderate work (standing, walking): | Unable |
21. Heavy work (push/pulling, climbing, carrying): | None at all |
22. Recreational activities: | Slight |
Select the level of pain | |
23. General level of pain: | Moderate |
24. Pain at rest: | Extreme |
25. Pain during your normal activity: | Unable |
26. Pain first thing in the morning: | None at all |
FADI Score (in %): | 75 |
FADI Score (in %): | 75 |
- Create a HIPAA compliant FADI 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 FADI form responses to Google Sheets and sending them on email
- Prepopulate patient details in FADI 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.
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
October 31, 2023
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
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— Myles Sicuro
July 12, 2023
It very friendly to used. I love it. For my case multiple signature needed. it's supporting
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November 27, 2023
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— 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