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Use our readymade template to create your Psychological Wellbeing Scale (WBS) for assessing individual's well-being
Create your care assessments
- Prebuilt template with WBS scoring to assess the presence of psychological well-being and measure its severity
- 18-item questionnaire that scores each item as “1” (strongly disagree) to “7” (strongly agree)
- Real-time calculation of WBS Score and well-being severity 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 psychological well-being
- 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 |
| 1. I like most parts of my personality. | Somewhat agree |
| 2. When I look at the story of my life, I am pleased with how things have turned out so far. | Strongly agree |
| 3. Some people wander aimlessly through life, but I am not one of them. | A little agree |
| 4. The demands of everyday life often get me down. | Neither agree or disagree |
| 5. In many ways I feel disappointed about my achievements in life. | A little disagree |
| 6. Maintaining close relationships has been difficult and frustrating for me. | Somewhat disagree |
| 7. I live life one day at a time and don't really think about the future. | Strongly disagree |
| 8. In general, I feel I am in charge of the situation in which I live. | Strongly agree |
| 9. I am good at managing the responsibilities of daily life. | Somewhat agree |
| 10. I sometimes feel as if I've done all there is to do in life. | A little agree |
| 11. For me, life has been a continuous process of learning, changing, and growth. | Neither agree or disagree |
| 12. I think it is important to have new experiences that challenge how I think about myself and the world. | A little disagree |
| 13. People would describe me as a giving person, willing to share my time with others. | Somewhat disagree |
| 14. I gave up trying to make big improvements or changes in my life a long time ago | Strongly disagree |
| 15. I tend to be influenced by people with strong opinions. | Strongly agree |
| 16. I have not experienced many warm and trusting relationships with others. | Somewhat agree |
| 17. I have confidence in my own opinions, even if they are different from the way most other people think. | A little agree |
| 18. I judge myself by what I think is important, not by the values of what others think is important. | Neither agree or disagree |
| Autonomy | 16 |
| Environmental Mastery | 15 |
| Personal Growth | 14 |
| Positive Relations with Others | 13 |
| Purpose in Life | 12 |
| Self-Acceptance | 11 |
- Collect patient details such as patient id, name, email etc in the WBS assessment form
- Send an email invitation with a secure link for patients to complete their WBS assessment form prior to their visit
- Allow patients to save their progress and complete their WBS assessment form at a later time without losing any responses
- Set up an email template for your WBS assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their WBS score, diagnosis, next steps when they submit their WBS assessment
Track patient responses in Google Sheets
| A | B | C | D | E | |
|---|---|---|---|---|---|
| 1 | Name | Question | Answer | Score | Total Score |
| 2 | John W | 1. I like most parts of my personality. | Somewhat agree | 6 | 16 |
| 3 | John W | 2. When I look at the story of my life, I am pleased with how things have turned out so far. | Strongly agree | 7 | 16 |
| 4 | John W | 3. Some people wander aimlessly through life, but I am not one of them. | A little agree | 5 | 16 |
| 5 | John W | 4. The demands of everyday life often get me down. | Neither agree or disagree | 4 | 16 |
| 6 | John W | 5. In many ways I feel disappointed about my achievements in life. | A little disagree | 5 | 16 |
| 7 | John W | 6. Maintaining close relationships has been difficult and frustrating for me. | Somewhat disagree | 6 | 16 |
| 8 | John W | 7. I live life one day at a time and don't really think about the future. | Strongly disagree | 7 | 16 |
| 9 | John W | 8. In general, I feel I am in charge of the situation in which I live. | Strongly agree | 7 | 16 |
| 10 | John W | 9. I am good at managing the responsibilities of daily life. | Somewhat agree | 6 | 16 |
| 11 | John W | 10. I sometimes feel as if I've done all there is to do in life. | A little agree | 3 | 16 |
| 12 | John W | 11. For me, life has been a continuous process of learning, changing, and growth. | Neither agree or disagree | 4 | 16 |
| 13 | John W | 12. I think it is important to have new experiences that challenge how I think about myself and the world. | A little disagree | 3 | 16 |
| 14 | John W | 13. People would describe me as a giving person, willing to share my time with others. | Somewhat disagree | 2 | 16 |
| 15 | John W | 14. I gave up trying to make big improvements or changes in my life a long time ago | Strongly disagree | 7 | 16 |
| 16 | John W | 15. I tend to be influenced by people with strong opinions. | Strongly agree | 1 | 16 |
| 17 | John W | 16. I have not experienced many warm and trusting relationships with others. | Somewhat agree | 2 | 16 |
| 18 | John W | 17. I have confidence in my own opinions, even if they are different from the way most other people think. | A little agree | 5 | 16 |
| 19 | John W | 18. I judge myself by what I think is important, not by the values of what others think is important. | Neither agree or disagree | 4 | 16 |
- Export patient responses including the calculated WBS score and well-being severity to Google Sheets for easy record-keeping
- Export individual points for 18 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 psychological well-being symptoms
- Receive a copy of the response and the calculated WBS score by email whenever a patient submits their WBS 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. I like most parts of my personality.: | Somewhat agree |
| 2. When I look at the story of my life, I am pleased with how things have turned out so far.: | Strongly agree |
| 3. Some people wander aimlessly through life, but I am not one of them.: | A little agree |
| 4. The demands of everyday life often get me down.: | Neither agree or disagree |
| 5. In many ways I feel disappointed about my achievements in life.: | A little disagree |
| 6. Maintaining close relationships has been difficult and frustrating for me.: | Somewhat disagree |
| 7. I live life one day at a time and don't really think about the future.: | Strongly disagree |
| 8. In general, I feel I am in charge of the situation in which I live.: | Strongly agree |
| 9. I am good at managing the responsibilities of daily life.: | Somewhat agree |
| 10. I sometimes feel as if I've done all there is to do in life.: | A little agree |
| 11. For me, life has been a continuous process of learning, changing, and growth.: | Neither agree or disagree |
| 12. I think it is important to have new experiences that challenge how I think about myself and the world.: | A little disagree |
| 13. People would describe me as a giving person, willing to share my time with others.: | Somewhat disagree |
| 14. I gave up trying to make big improvements or changes in my life a long time ago: | Strongly disagree |
| 15. I tend to be influenced by people with strong opinions.: | Strongly agree |
| 16. I have not experienced many warm and trusting relationships with others.: | Somewhat agree |
| 17. I have confidence in my own opinions, even if they are different from the way most other people think.: | A little agree |
| 18. I judge myself by what I think is important, not by the values of what others think is important.: | Neither agree or disagree |
| Autonomy: | 16 |
| Environmental Mastery: | 15 |
| Personal Growth: | 14 |
| Positive Relations with Others: | 13 |
| Purpose in Life: | 12 |
| Self-Acceptance: | 11 |
| Autonomy: | 16 |
- Create a HIPAA compliant WBS 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 WBS form responses to Google Sheets and sending them on email
- Prepopulate patient details in WBS 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
5 stars
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October 31, 2023
5 stars
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February 16, 2024
1 stars
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July 12, 2023
5 stars
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November 27, 2023
5 stars
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July 10, 2023
5 stars
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