Alcohol Use Disorders Identification Test
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Use our readymade template to create your AUDIT screening tool for alcohol use disorders

Create your care assessments

AUDIT score Diagnosis Proposed treatment
0 Abstainer No treatment
1-7 Low-risk consumption Advice on reducing alcohol consumption
8-14 Hazardous or harmful alcohol consumption Brief counseling and continued monitoring
15-19 Moderate-severe alcohol use disorder Referral to specialist for diagnostic evaluation and treatment
20-40 Severe alcohol use disorder Referral to specialist for diagnostic evaluation and treatment
  • navigate_next Prebuilt template with AUDIT scoring to assess the presence of alcohol use disorders and measure its severity
  • navigate_next 10-item questionnaire that scores each item on a scale of 0 to 4
  • navigate_next Real-time calculation of AUDIT Score and diagnosis based on the form responses
  • navigate_next Collect patient data and other sensitive healthcare data using our HIPAA compliant online assessment forms
  • navigate_next Compare the scores from the initial screening with that of the followup to track the progression of alcohol use disorders
  • navigate_next 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 often do you have a drink containing alcohol? 2-3 times a week
How many standard drinks containing alcohol do you have on a typical day when drinking? 3 or 4
How often do you have six or more drinks on one occasion? Monthly
During the past year, how often have you found that you were not able to stop drinking once you had started? Less than monthly
During the past year, how often have you failed to do what was normally expected of you because of drinking? Never
During the past year, how often have you needed a drink in the morning to get yourself going after a heavy drinking session? Never
During the past year, how often have you had a feeling of guilt or remorse after drinking? Less than monthly
During the past year, how often have you been unable to remember what happened the night before because you had been drinking? Never
Have you or someone else been injured as a result of your drinking? No
Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested you cut down? No
AUDIT Score 8
Diagnosis Hazardous or harmful alcohol consumption
  • navigate_next Pre-populate patient details such as patient id, name, email etc in the AUDIT assessment form before sharing it with the patients
  • navigate_next Send an email invitation with a secure link for patients to complete their AUDIT assessment form prior to their visit
  • navigate_next Allow patients to save their progress and complete their AUDIT assessment form at a later time without losing any responses
  • navigate_next Set up an email template for your AUDIT assessment and automatically send invitation emails to multiple patients with ease
  • navigate_next Send a confirmation email to the patients with their AUDIT score, diagnosis, next steps when they submit their AUDIT assessment

Track patient responses in Google Sheets

A B C D E
1 Name Question Answer Score Total Score
2 John W How often do you have a drink containing alcohol? 2-3 times a week 3 8
3 John W How many standard drinks containing alcohol do you have on a typical day when drinking? 3 or 4 1 8
4 John W How often do you have six or more drinks on one occasion? Monthly 2 8
5 John W During the past year, how often have you found that you were not able to stop drinking once you had started? Less than monthly 1 8
6 John W During the past year, how often have you failed to do what was normally expected of you because of drinking? Never 0 8
7 John W During the past year, how often have you needed a drink in the morning to get yourself going after a heavy drinking session? Never 0 8
8 John W During the past year, how often have you had a feeling of guilt or remorse after drinking? Less than monthly 1 8
9 John W During the past year, how often have you been unable to remember what happened the night before because you had been drinking? Never 0 8
10 John W Have you or someone else been injured as a result of your drinking? No 0 8
11 John W Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested you cut down? No 0 8
  • navigate_next Export patient responses including the calculated AUDIT score and diagnosis to Google Sheets for easy record-keeping
  • navigate_next Export individual points for 10 items to Google Sheets for data manipulation and analysis for comprehensive insights
  • navigate_next Use pre-built reports to easily keep track of patient progress over time and monitor changes in their alcohol use patterns
  • navigate_next Receive a copy of the response and the calculated AUDIT score by email whenever a patient submits their AUDIT assessment
  • navigate_next 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 often do you have a drink containing alcohol? : 2-3 times a week
How many standard drinks containing alcohol do you have on a typical day when drinking?: 3 or 4
How often do you have six or more drinks on one occasion?: Monthly
During the past year, how often have you found that you were not able to stop drinking once you had started?: Less than monthly
During the past year, how often have you failed to do what was normally expected of you because of drinking?: Never
During the past year, how often have you needed a drink in the morning to get yourself going after a heavy drinking session?: Never
During the past year, how often have you had a feeling of guilt or remorse after drinking?: Less than monthly
During the past year, how often have you been unable to remember what happened the night before because you had been drinking?: Never
Have you or someone else been injured as a result of your drinking?: No
Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested you cut down?: No
AUDIT Score: 8
Diagnosis: Hazardous or harmful alcohol consumption
AUDIT Score: 8
Diagnosis: Hazardous or harmful alcohol consumption
  • navigate_next Create a HIPAA compliant AUDIT assessment form to safely collect, store and access patient responses
  • navigate_next Mark fields as Protected Health Information (PHI) to secure sensitive patient data and limit access to PHI
  • navigate_next Automatically mask PHI fields when exporting AUDIT form responses to Google Sheets and sending them on email
  • navigate_next Prepopulate patient details in AUDIT assessments by creating secure prefill links without exposing PHI
  • navigate_next 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

5 stars

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

5 stars

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

1 stars

Does not work

— Myles Sicuro

October 30, 2023

5 stars

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

5 stars

It very friendly to used. I love it. For my case multiple signature needed. it's supporting

— Senthil Kumar

November 27, 2023

5 stars

Yeah this is good for all

— luqman khan

July 10, 2023

5 stars

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

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