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Headache Disability Index
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Use our readymade template to create your Headache Disability Index (HDI) assessment tool

Create your care assessments

HDI score Disability Level Proposed treatment
0-9 No disability May not need treatment
10-29 Mild disability Consider counseling
30-49 Moderate disability Consider medication
50-71 Severe disability Active treatment
72-100 Complete disability Immediate initiation
  • navigate_next Prebuilt template with HDI scoring to assess the presence of headache disorders and measure their impact
  • navigate_next 25-item questionnaire that scores each item as “Yes” (4 points), “Sometimes” (2 points), or “No” (0 points)
  • navigate_next Real-time calculation of HDI Score and disability level 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 headache 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
I have a headache: more than once but less than four times per month
My headache is: moderate
Because of my headaches I feel disabled. Sometimes
Because of my headaches I feel restricted in performing my routine daily activities. Yes
No one understands the effect my headaches have on my life. No
I restrict my recreational activities (eg, sports, hobbies) because of my headaches. Yes
My headaches make me angry. Sometimes
Sometimes I feel that I am going to lose control because of my headaches. No
Because of my headaches I am less likely to socialize. Yes
My spouse (significant other), or family and friends have no idea what I am going through because of my headaches. Sometimes
My headaches are so bad that I feel that I am going to go insane. No
My outlook on the world is affected by my headaches. Yes
I am afraid to go outside when I feel that a headaches is starting. Sometimes
I feel desperate because of my headaches. No
I am concerned that I am paying penalties at work or at home because of my headaches. Yes
My headaches place stress on my relationships with family or friends. Sometimes
I avoid being around people when I have a headache. No
I believe my headaches are making it difficult for me to achieve my goals in life. Yes
I am unable to think clearly because of my headaches. Sometimes
I get tense (e.g., muscle tension) because of my headaches. No
I do not enjoy social gatherings because of my headaches. Yes
I feel irritable because of my headaches. Sometimes
I avoid traveling because of my headaches. No
My headaches make me feel confused. Yes
My headaches make me feel frustrated. Sometimes
I find it difficult to read because of my headaches. No
I find it difficult to focus my attention away from my headaches and on other things. Yes
Emotional score 24
Functional score 20
HDI score 44
Disability Level mild disability
  • navigate_next Pre-populate patient details such as patient id, name, email etc in the HDI assessment form before sharing it with the patients
  • navigate_next Send an email invitation with a secure link for patients to complete their HDI assessment form prior to their visit
  • navigate_next Allow patients to save their progress and complete their HDI assessment form at a later time without losing any responses
  • navigate_next Set up an email template for your HDI assessment and automatically send invitation emails to multiple patients with ease
  • navigate_next Send a confirmation email to the patients with their HDI score, diagnosis, next steps when they submit their HDI assessment

Track patient responses in Google Sheets

A B C D E
1 Name Question Answer Score Total Score
2 John W Because of my headaches I feel disabled. Sometimes 2 44
3 John W Because of my headaches I feel restricted in performing my routine daily activities. Yes 4 44
4 John W No one understands the effect my headaches have on my life. No 0 44
5 John W I restrict my recreational activities (eg, sports, hobbies) because of my headaches. Yes 4 44
6 John W My headaches make me angry. Sometimes 2 44
7 John W Sometimes I feel that I am going to lose control because of my headaches. No 0 44
8 John W Because of my headaches I am less likely to socialize. Yes 4 44
9 John W My spouse (significant other), or family and friends have no idea what I am going through because of my headaches. Sometimes 2 44
10 John W My headaches are so bad that I feel that I am going to go insane. No 0 44
11 John W My outlook on the world is affected by my headaches. Yes 4 44
12 John W I am afraid to go outside when I feel that a headaches is starting. Sometimes 2 44
13 John W I feel desperate because of my headaches. No 0 44
14 John W I am concerned that I am paying penalties at work or at home because of my headaches. Yes 4 44
15 John W My headaches place stress on my relationships with family or friends. Sometimes 2 44
16 John W I avoid being around people when I have a headache. No 0 44
17 John W I believe my headaches are making it difficult for me to achieve my goals in life. Yes 4 44
18 John W I am unable to think clearly because of my headaches. Sometimes 2 44
19 John W I get tense (e.g., muscle tension) because of my headaches. No 0 44
20 John W I do not enjoy social gatherings because of my headaches. Yes 4 44
21 John W I feel irritable because of my headaches. Sometimes 2 44
22 John W I avoid traveling because of my headaches. No 0 44
23 John W My headaches make me feel confused. Yes 4 44
24 John W My headaches make me feel frustrated. Sometimes 2 44
25 John W I find it difficult to read because of my headaches. No 0 44
26 John W I find it difficult to focus my attention away from my headaches and on other things. Yes 4 44
  • navigate_next Export patient responses including the calculated HDI score and disability level to Google Sheets for easy record-keeping
  • navigate_next Export individual points for 25 items 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 headache symptoms
  • navigate_next Receive a copy of the response and the calculated HDI score by email whenever a patient submits their HDI 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
I have a headache: : more than once but less than four times per month
My headache is: : moderate
Because of my headaches I feel disabled.: Sometimes
Because of my headaches I feel restricted in performing my routine daily activities.: Yes
No one understands the effect my headaches have on my life.: No
I restrict my recreational activities (eg, sports, hobbies) because of my headaches.: Yes
My headaches make me angry.: Sometimes
Sometimes I feel that I am going to lose control because of my headaches.: No
Because of my headaches I am less likely to socialize.: Yes
My spouse (significant other), or family and friends have no idea what I am going through because of my headaches.: Sometimes
My headaches are so bad that I feel that I am going to go insane.: No
My outlook on the world is affected by my headaches.: Yes
I am afraid to go outside when I feel that a headaches is starting.: Sometimes
I feel desperate because of my headaches.: No
I am concerned that I am paying penalties at work or at home because of my headaches.: Yes
My headaches place stress on my relationships with family or friends.: Sometimes
I avoid being around people when I have a headache.: No
I believe my headaches are making it difficult for me to achieve my goals in life.: Yes
I am unable to think clearly because of my headaches.: Sometimes
I get tense (e.g., muscle tension) because of my headaches.: No
I do not enjoy social gatherings because of my headaches.: Yes
I feel irritable because of my headaches.: Sometimes
I avoid traveling because of my headaches.: No
My headaches make me feel confused.: Yes
My headaches make me feel frustrated.: Sometimes
I find it difficult to read because of my headaches.: No
I find it difficult to focus my attention away from my headaches and on other things.: Yes
Emotional score: 24
Functional score: 20
HDI score: 44
Disability Level: mild disability
HDI score: 44
Disability Level: mild disability
  • navigate_next Create a HIPAA compliant HDI 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 HDI form responses to Google Sheets and sending them on email
  • navigate_next Prepopulate patient details in HDI 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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