Use our readymade template to create your Lower Extremity Functional Scale (LEFS) for assessing patients with lower limb problems
Create your care assessments
| LEFS score | Severity |
|---|---|
| 0-20 | Severe |
| 21-40 | Moderate |
| 41-60 | Mild |
| 61-80 | Minimal |
- Prebuilt template with LEFS scoring to assess the presence and severity of lower limb problems
- 20-item questionnaire that scores each item from “0” (Extreme Difficulty or Unable to Perform Activity) to “4” (No Difficulty)
- Real-time calculation of LEFS 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 lower limb problems
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. Any of usual work, housework or school activities. | A Little Bit of Difficulty |
| 2. Your usual hobbies, recreational or sporting activities. | Moderate Difficulty |
| 3. Getting into or out of the bath. | No Difficulty |
| 4. Walking between rooms. | Quite a Bit of Difficulty |
| 5. Putting on your shoes or socks. | No Difficulty |
| 6. Squatting. | A Little Bit of Difficulty |
| 7. Lifting an object, like a bag of groceries from the floor. | Moderate Difficulty |
| 8. Performing light activities around your home. | No Difficulty |
| 9. Performing heaving activities around your home. | Quite a Bit of Difficulty |
| 10. Getting into or out of a car. | No Difficulty |
| 11. Walking 2 blocks. | A Little Bit of Difficulty |
| 12. Walking a mile. | Moderate Difficulty |
| 13. Going up or down 10 stairs (about 1 flight of stairs). | No Difficulty |
| 14. Standing for 1 hour. | Quite a Bit of Difficulty |
| 15. Sitting for 1 hour. | No Difficulty |
| 16. Running on even ground. | A Little Bit of Difficulty |
| 17. Running on uneven ground. | Moderate Difficulty |
| 18. Making sharp turns while running fast. | No Difficulty |
| 19. Hopping. | A Little Bit of Difficulty |
| 20. Rolling over in bed. | No Difficulty |
| LEFS Score | 60 |
- Pre-populate patient details such as patient id, name, email etc in the LEFS assessment form before sharing it with the patients
- Send an email invitation with a secure link for patients to complete their LEFS assessment form prior to their visit
- Allow patients to save their progress and complete their LEFS assessment form at a later time without losing any responses
- Set up an email template for your LEFS assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their LEFS score, diagnosis, next steps when they submit their LEFS assessment
Track patient responses in Google Sheets
| A | B | C | D | E | |
|---|---|---|---|---|---|
| 1 | Name | Question | Answer | Score | Total Score |
| 2 | John W | 1. Any of usual work, housework or school activities. | A Little Bit of Difficulty | 3 | 60 |
| 3 | John W | 2. Your usual hobbies, recreational or sporting activities. | Moderate Difficulty | 2 | 60 |
| 4 | John W | 3. Getting into or out of the bath. | No Difficulty | 4 | 60 |
| 5 | John W | 4. Walking between rooms. | Quite a Bit of Difficulty | 1 | 60 |
| 6 | John W | 5. Putting on your shoes or socks. | No Difficulty | 4 | 60 |
| 7 | John W | 6. Squatting. | A Little Bit of Difficulty | 3 | 60 |
| 8 | John W | 7. Lifting an object, like a bag of groceries from the floor. | Moderate Difficulty | 2 | 60 |
| 9 | John W | 8. Performing light activities around your home. | No Difficulty | 4 | 60 |
| 10 | John W | 9. Performing heaving activities around your home. | Quite a Bit of Difficulty | 1 | 60 |
| 11 | John W | 10. Getting into or out of a car. | No Difficulty | 4 | 60 |
| 12 | John W | 11. Walking 2 blocks. | A Little Bit of Difficulty | 3 | 60 |
| 13 | John W | 12. Walking a mile. | Moderate Difficulty | 2 | 60 |
| 14 | John W | 13. Going up or down 10 stairs (about 1 flight of stairs). | No Difficulty | 4 | 60 |
| 15 | John W | 14. Standing for 1 hour. | Quite a Bit of Difficulty | 1 | 60 |
| 16 | John W | 15. Sitting for 1 hour. | No Difficulty | 4 | 60 |
| 17 | John W | 16. Running on even ground. | A Little Bit of Difficulty | 3 | 60 |
| 18 | John W | 17. Running on uneven ground. | Moderate Difficulty | 2 | 60 |
| 19 | John W | 18. Making sharp turns while running fast. | No Difficulty | 4 | 60 |
| 20 | John W | 19. Hopping. | A Little Bit of Difficulty | 3 | 60 |
| 21 | John W | 20. Rolling over in bed. | No Difficulty | 4 | 60 |
- Export patient responses including the calculated LEFS score to Google Sheets for easy record-keeping
- Export individual points for 20 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 lower limb problems
- Receive a copy of the response and the calculated LEFS score by email whenever a patient submits their LEFS 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 |
| 1. Any of usual work, housework or school activities.: | A Little Bit of Difficulty |
| 2. Your usual hobbies, recreational or sporting activities. : | Moderate Difficulty |
| 3. Getting into or out of the bath.: | No Difficulty |
| 4. Walking between rooms.: | Quite a Bit of Difficulty |
| 5. Putting on your shoes or socks.: | No Difficulty |
| 6. Squatting.: | A Little Bit of Difficulty |
| 7. Lifting an object, like a bag of groceries from the floor. : | Moderate Difficulty |
| 8. Performing light activities around your home.: | No Difficulty |
| 9. Performing heaving activities around your home.: | Quite a Bit of Difficulty |
| 10. Getting into or out of a car.: | No Difficulty |
| 11. Walking 2 blocks.: | A Little Bit of Difficulty |
| 12. Walking a mile.: | Moderate Difficulty |
| 13. Going up or down 10 stairs (about 1 flight of stairs).: | No Difficulty |
| 14. Standing for 1 hour.: | Quite a Bit of Difficulty |
| 15. Sitting for 1 hour.: | No Difficulty |
| 16. Running on even ground.: | A Little Bit of Difficulty |
| 17. Running on uneven ground.: | Moderate Difficulty |
| 18. Making sharp turns while running fast.: | No Difficulty |
| 19. Hopping.: | A Little Bit of Difficulty |
| 20. Rolling over in bed.: | No Difficulty |
| LEFS Score: | 60 |
| LEFS Score: | 60 |
- Create a HIPAA compliant LEFS 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 LEFS form responses to Google Sheets and sending them on email
- Prepopulate patient details in LEFS 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.
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