Use our readymade template to create your Cumberland Ankle Instability Tool (CAIT) for assessing the severity of functional ankle instability
Create your care assessments
| CAIT score | Ankle Instability Severity |
|---|---|
| 28-30 | None |
| 24-27 | Mild |
| 19-23 | Moderate |
| 0-18 | Severe |
- 9-item questionnaire that scores each item on a scale, with a total score ranging from 0 to 30
- Real-time calculation of CAIT 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 ankle instability
- 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 have pain in my ankle | During sport |
| 2. My ankle feels UNSTABLE | Sometimes during sport (not every time) |
| 3. When I make SHARP turns, my ankle feels UNSTABLE | Somtimes when running |
| 4. When going down the stairs, my ankle feels UNSTABLE | If I go fast |
| 5. My ankle feels UNSTABLE when standing on ONE leg | On the ball of my foot |
| 6. My ankle feels UNSTABLE when | I hop from side to side |
| 7. My ankle feels UNSTABLE when | I run on uneven surfaces |
| 8. TYPICALLY, when I start to roll over (or “twist”) on my ankle, I can stop it | Immediately |
| 9. After a TYPICAL incident of my ankle rolling over, my ankle return to "normal" | Almost immediately |
| CAIT Score | 26 |
- Pre-populate patient details such as patient id, name, email etc in the CAIT assessment form before sharing it with the patients
- Send an email invitation with a secure link for patients to complete their CAIT assessment form prior to their visit
- Allow patients to save their progress and complete their CAIT assessment form at a later time without losing any responses
- Set up an email template for your CAIT assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their CAIT score, diagnosis, next steps when they submit their CAIT assessment
Track patient responses in Google Sheets
| A | B | C | D | E | |
|---|---|---|---|---|---|
| 1 | Name | Question | Answer | Score | Total Score |
| 2 | John W | 1. I have pain in my ankle | During sport | 4 | 26 |
| 3 | John W | 2. My ankle feels UNSTABLE | Sometimes during sport (not every time) | 3 | 26 |
| 4 | John W | 3. When I make SHARP turns, my ankle feels UNSTABLE | Somtimes when running | 2 | 26 |
| 5 | John W | 4. When going down the stairs, my ankle feels UNSTABLE | If I go fast | 2 | 26 |
| 6 | John W | 5. My ankle feels UNSTABLE when standing on ONE leg | On the ball of my foot | 1 | 26 |
| 7 | John W | 6. My ankle feels UNSTABLE when | I hop from side to side | 2 | 26 |
| 8 | John W | 7. My ankle feels UNSTABLE when | I run on uneven surfaces | 3 | 26 |
| 9 | John W | 8. TYPICALLY, when I start to roll over (or “twist”) on my ankle, I can stop it | Immediately | 3 | 26 |
| 10 | John W | 9. After a TYPICAL incident of my ankle rolling over, my ankle return to "normal" | Almost immediately | 3 | 26 |
- Export patient responses including the calculated CAIT 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 ankle instability symptoms
- Receive a copy of the response and the calculated CAIT score by email whenever a patient submits their CAIT 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 have pain in my ankle : | During sport |
| 2. My ankle feels UNSTABLE: | Sometimes during sport (not every time) |
| 3. When I make SHARP turns, my ankle feels UNSTABLE: | Somtimes when running |
| 4. When going down the stairs, my ankle feels UNSTABLE: | If I go fast |
| 5. My ankle feels UNSTABLE when standing on ONE leg: | On the ball of my foot |
| 6. My ankle feels UNSTABLE when: | I hop from side to side |
| 7. My ankle feels UNSTABLE when: | I run on uneven surfaces |
| 8. TYPICALLY, when I start to roll over (or “twist”) on my ankle, I can stop it: | Immediately |
| 9. After a TYPICAL incident of my ankle rolling over, my ankle return to "normal": | Almost immediately |
| CAIT Score: | 26 |
| CAIT Score: | 26 |
- Create a HIPAA compliant CAIT 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 CAIT form responses to Google Sheets and sending them on email
- Prepopulate patient details in CAIT 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 27, 2023
I am 100% a fan of this company. We use HIPAA compliant Google Forms and needed a way to collect signatures, the industry standard company is TOO expensive. I started using FormEsign and it worked perfectly. It lacked the ability to provide a pdf copy of the form after signature. This company worked with me help their product evolve into something that could benefit all future clients AND the end user. The team was polite, professional, kind, enthusiastic, and willing to make a change. This earned my loyalty. I will sing their praises. Good work, and thank you!
— Royal Bush
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
February 16, 2024
Does not work
— Myles Sicuro
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
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