Use our readymade template to create your Insomnia Severity Index (ISI) screening tool for insomnia
Create your care assessments
| ISI score | Insomnia Level | Proposed treatment |
|---|---|---|
| 0-7 | No clinically significant insomnia | May not need treatment |
| 8-14 | Subthreshold insomnia | Watchful waiting |
| 15-21 | Clinical insomnia (moderate severity) | Consider counseling |
| 22-28 | Clinical insomnia (severe) | Active treatment |
- Prebuilt template with ISI scoring to assess the presence of insomnia and measure its severity
- 7-item questionnaire that scores each of the 7 criteria as “0” (None) to “4” (Very Severe)
- Real-time calculation of ISI Score and insomnia level 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 insomnia
- 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 |
| Please rate the CURRENT (i.e. LAST 2 WEEKS) SEVERITY of your insomnia problem(s). | |
| Difficulty falling asleep | Moderate |
| Difficulty staying asleep | Severe |
| Problems waking up too early | Very Severe |
| How SATISFIED/DISSATISFIED are you with your CURRENT sleep pattern? | Dissatisfied |
| How NOTICEABLE to others do you think your sleep problem is in terms of impairing the quality of your life? | Much |
| How WORRIED/DISTRESSED are you about your current sleep problem | Very Much Noticeable |
| To what extent do you consider your sleep problem to INTERFERE with your daily functioning (e.g. daytime fatigue, mood, ability to function at work/daily chores, concentration, memory, mood, etc.) CURRENTLY? | Very Much Interfering |
| ISI Score | 23 |
| Insomnia Level | Clinical insomnia (severe) |
- Pre-populate patient details such as patient id, name, email etc in the ISI assessment form before sharing it with the patients
- Send an email invitation with a secure link for patients to complete their ISI assessment form prior to their visit
- Allow patients to save their progress and complete their ISI assessment form at a later time without losing any responses
- Set up an email template for your ISI assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their ISI score, diagnosis, next steps when they submit their ISI assessment
Track patient responses in Google Sheets
| A | B | C | D | E | |
|---|---|---|---|---|---|
| 1 | Name | Question | Answer | Score | Total Score |
| 2 | John W | Difficulty falling asleep | Moderate | 2 | 23 |
| 3 | John W | Difficulty staying asleep | Severe | 3 | 23 |
| 4 | John W | Problems waking up too early | Very Severe | 4 | 23 |
| 5 | John W | How SATISFIED/DISSATISFIED are you with your CURRENT sleep pattern? | Dissatisfied | 3 | 23 |
| 6 | John W | How NOTICEABLE to others do you think your sleep problem is in terms of impairing the quality of your life? | Much | 3 | 23 |
| 7 | John W | How WORRIED/DISTRESSED are you about your current sleep problem | Very Much Noticeable | 4 | 23 |
| 8 | John W | To what extent do you consider your sleep problem to INTERFERE with your daily functioning (e.g. daytime fatigue, mood, ability to function at work/daily chores, concentration, memory, mood, etc.) CURRENTLY? | Very Much Interfering | 4 | 23 |
- Export patient responses including the calculated ISI score and insomnia level to Google Sheets for easy record-keeping
- Export individual points for 7 criteria 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 insomnia symptoms
- Receive a copy of the response and the calculated ISI score by email whenever a patient submits their ISI 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: | ****** |
| Please rate the CURRENT (i.e. LAST 2 WEEKS) SEVERITY of your insomnia problem(s). | |
| Difficulty falling asleep: | Moderate |
| Difficulty staying asleep: | Severe |
| Problems waking up too early: | Very Severe |
| How SATISFIED/DISSATISFIED are you with your CURRENT sleep pattern?: | Dissatisfied |
| How NOTICEABLE to others do you think your sleep problem is in terms of impairing the quality of your life?: | Much |
| How WORRIED/DISTRESSED are you about your current sleep problem : | Very Much Noticeable |
| To what extent do you consider your sleep problem to INTERFERE with your daily functioning (e.g. daytime fatigue, mood, ability to function at work/daily chores, concentration, memory, mood, etc.) CURRENTLY?: | Very Much Interfering |
| ISI Score: | 23 |
| Insomnia Level: | Clinical insomnia (severe) |
| ISI Score: | 23 |
| Insomnia Level: | Clinical insomnia (severe) |
- Create a HIPAA compliant ISI 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 ISI form responses to Google Sheets and sending them on email
- Prepopulate patient details in ISI 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
Does not work
— Myles Sicuro
July 12, 2023
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November 27, 2023
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July 10, 2023
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