Use our readymade template to create your STOP-Bang Sleep Apnea Questionnaire
Create your care assessments
| STOP-Bang score | OSA Risk |
|---|---|
| 0-2 | Low |
| 3-4 | Intermediate |
| 5-8 | High |
- Prebuilt template with STOP-Bang scoring to assess the risk of Obstructive Sleep Apnea
- 8-item questionnaire that scores each of the 8 criteria as “0” (No) to “1” (Yes)
- Real-time calculation of STOP-Bang 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 |
| Snoring | Yes |
| Tired | No |
| Observed | Yes |
| Pressure | No |
| BMI | Yes |
| Age | Yes |
| Neck size large | No |
| Gender | Male |
| STOP-BANG Score | 5 |
| OSA Risk | High |
- Pre-populate patient details such as patient id, name, email etc in the STOP-Bang assessment form before sharing it with the patients
- Send an email invitation with a secure link for patients to complete their STOP-Bang assessment form prior to their visit
- Allow patients to save their progress and complete their STOP-Bang assessment form at a later time without losing any responses
- Set up an email template for your STOP-Bang assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their STOP-Bang score, diagnosis, next steps when they submit their STOP-Bang assessment
Track patient responses in Google Sheets
| A | B | C | D | E | |
|---|---|---|---|---|---|
| 1 | Name | Question | Answer | Score | Total Score |
| 2 | John W | Snoring | Yes | 1 | 5 |
| 3 | John W | Tired | No | 0 | 5 |
| 4 | John W | Observed | Yes | 1 | 5 |
| 5 | John W | Pressure | No | 0 | 5 |
| 6 | John W | BMI | Yes | 1 | 5 |
| 7 | John W | Age | Yes | 1 | 5 |
| 8 | John W | Neck size large | No | 0 | 5 |
| 9 | John W | Gender | Male | 1 | 5 |
- Export patient responses including the calculated STOP-Bang score to Google Sheets for easy record-keeping
- Export individual points for 8 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 sleep apnea symptoms
- Receive a copy of the response and the calculated STOP-Bang score by email whenever a patient submits their STOP-Bang 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 |
| Snoring: | Yes |
| Tired: | No |
| Observed: | Yes |
| Pressure: | No |
| BMI: | Yes |
| Age: | Yes |
| Neck size large: | No |
| Gender: | Male |
| STOP-BANG Score: | 5 |
| OSA Risk: | High |
| STOP-BANG Score: | 5 |
| OSA Risk: | High |
- Create a HIPAA compliant STOP-Bang 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 STOP-Bang form responses to Google Sheets and sending them on email
- Prepopulate patient details in STOP-Bang 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
It very friendly to used. I love it. For my case multiple signature needed. it's supporting
— Senthil Kumar
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