Use our readymade template to create your Neuropathic Pain Scale (NPS) for assessing neuropathic pain
Create your care assessments
| NPS score | Pain Severity |
|---|---|
| 0-30 | Mild |
| 31-70 | Moderate |
| 71-110 | Severe |
- 11-item questionnaire that scores each item on a scale of 0 to 10
- Real-time calculation of NPS Score 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 |
| Doctor's Name | Dr. Smith |
| Location | New York |
| How intense is the pain? | 5 |
| How sharp is the pain? | 4 |
| How hot is the pain? | 3 |
| How dull is the pain? | 2 |
| How cold is the pain? | 1 |
| How sensitive is the skin to light touch? | 6 |
| How itchy is the pain? | 7 |
| How unpleasant is the pain? | 8 |
| If the pain is deep, how intense is the deep pain? | 9 |
| If the pain is on the surface, how intense is the surface pain? | 10 |
| What is the time quality of the pain? | Background pain present all the time, with occasional flare-ups (breakthrough pain) |
| NPS score | 55 |
- Allow patients to save their progress and complete their NPS assessment form at a later time without losing any responses
- Set up an email template for your NPS assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their NPS score, diagnosis, next steps when they submit their NPS assessment
Track patient responses in Google Sheets
| A | B | C | D | E | |
|---|---|---|---|---|---|
| 1 | Name | Question | Answer | Score | Total Score |
| 2 | John W | How intense is the pain? | 5 | 5 | 55 |
| 3 | John W | How sharp is the pain? | 4 | 4 | 55 |
| 4 | John W | How hot is the pain? | 3 | 3 | 55 |
| 5 | John W | How dull is the pain? | 2 | 2 | 55 |
| 6 | John W | How cold is the pain? | 1 | 1 | 55 |
| 7 | John W | How sensitive is the skin to light touch? | 6 | 6 | 55 |
| 8 | John W | How itchy is the pain? | 7 | 7 | 55 |
| 9 | John W | How unpleasant is the pain? | 8 | 8 | 55 |
| 10 | John W | If the pain is deep, how intense is the deep pain? | 9 | 9 | 55 |
| 11 | John W | If the pain is on the surface, how intense is the surface pain? | 10 | 10 | 55 |
- Export patient responses including the calculated NPS 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 neuropathic pain symptoms
- Receive a copy of the response and the calculated NPS score by email whenever a patient submits their NPS 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 |
| How intense is the pain?: | 5 |
| How sharp is the pain?: | 4 |
| How hot is the pain?: | 3 |
| How dull is the pain?: | 2 |
| How cold is the pain?: | 1 |
| How sensitive is the skin to light touch?: | 6 |
| How itchy is the pain?: | 7 |
| How unpleasant is the pain?: | 8 |
| If the pain is deep, how intense is the deep pain?: | 9 |
| If the pain is on the surface, how intense is the surface pain?: | 10 |
| What is the time quality of the pain?: | Background pain present all the time, with occasional flare-ups (breakthrough pain) |
| NPS score: | 55 |
| NPS score: | 55 |
- Create a HIPAA compliant NPS 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 NPS form responses to Google Sheets and sending them on email
- 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