Drug Abuse Screening Test
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Use our readymade template to create your DAST screening tool for drug abuse

Create your care assessments

DAST score Diagnosis Proposed treatment
0-5 No substance use disorders May not need treatment
6-11 Screen for substance use disorders Consider counseling
12-28 Definitely a substance abuse problem Active treatment
  • navigate_next Prebuilt template with DAST scoring to assess the presence of drug abuse and measure its severity
  • navigate_next 28-item questionnaire that scores each of the 28 DSM-IV criteria as “Yes” (1 point) or “No” (0 point)
  • navigate_next Real-time calculation of DAST 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 drug abuse
  • 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
Please select an answer for every question
1. Have you used drugs other than those required for medical reasons? Yes
2. Have you abused prescription drugs? No
3. Do you abuse more than one drug at a time? Yes
4. Can you get through the week without using drugs (other than those required for medical reasons)? No
5. Are you always able to stop using drugs when you want to? Yes
6. Do you abuse drugs on a continuous basis? No
7. Do you try to limit your drug use to certain situations? Yes
8. Have you had “blackouts” or “flashbacks” as a result of drug use? No
9. Do you ever feel bad about your drug abuse? Yes
10. Does your spouse (or parents) ever complain about your involvement with drugs? No
11. Do your friends or relatives know or suspect you abuse drugs? Yes
12. Has drug abuse ever created problems between you and your spouse? No
13. Has any family member ever sought help for problems related to your drug use? Yes
14. Have you ever lost friends because of your use of drugs? No
15. Have you ever neglected your family or missed work because of your use of drugs? Yes
16. Have you ever been in trouble at work because of drug abuse? No
17. Have you ever lost a job because of drug abuse? Yes
18. Have you gotten into fights when under the influence of drugs? No
19. Have you ever been arrested because of unusual behavior while under the influence of drugs? Yes
20. Have you ever been arrested for driving while under the influence of drugs? No
21. Have you engaged in illegal activities in order to obtain drug? Yes
22. Have you ever been arrested for possession of illegal drugs? No
23. Have you ever experienced withdrawal symptoms as a result of heavy drug intake? Yes
24. Have you had medical problems as a result of your drug use (e.g., memory loss, hepatitis, convulsions, bleeding, etc.)? No
25. Have you ever gone to anyone for help for a drug problem? Yes
26. Have you ever been in a hospital for medical problems related to your drug use? No
27. Have you ever been involved in a treatment program specifically related to drug use? Yes
28. Have you been treated as an outpatient for problems related to drug abuse? No
DAST Score 16
Diagnosis Screen for substance use disorders
  • navigate_next Pre-populate patient details such as patient id, name, email etc in the DAST assessment form before sharing it with the patients
  • navigate_next Send an email invitation with a secure link for patients to complete their DAST assessment form prior to their visit
  • navigate_next Allow patients to save their progress and complete their DAST assessment form at a later time without losing any responses
  • navigate_next Set up an email template for your DAST assessment and automatically send invitation emails to multiple patients with ease
  • navigate_next Send a confirmation email to the patients with their DAST score, diagnosis, next steps when they submit their DAST assessment

Track patient responses in Google Sheets

Assessment form builder
  • navigate_next Export patient responses including the calculated DAST score and diagnosis to Google Sheets for easy record-keeping
  • navigate_next Export individual points for 28 DSM-IV criteria 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 drug abuse symptoms
  • navigate_next Receive a copy of the response and the calculated DAST score by email whenever a patient submits their DAST 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
Please select an answer for every question
1. Have you used drugs other than those required for medical reasons?:Yes
2. Have you abused prescription drugs?:No
3. Do you abuse more than one drug at a time?:Yes
4. Can you get through the week without using drugs (other than those required for medical reasons)?:No
5. Are you always able to stop using drugs when you want to?:Yes
6. Do you abuse drugs on a continuous basis?:No
7. Do you try to limit your drug use to certain situations?:Yes
8. Have you had “blackouts” or “flashbacks” as a result of drug use?:No
9. Do you ever feel bad about your drug abuse?:Yes
10. Does your spouse (or parents) ever complain about your involvement with drugs?:No
11. Do your friends or relatives know or suspect you abuse drugs?:Yes
12. Has drug abuse ever created problems between you and your spouse?:No
13. Has any family member ever sought help for problems related to your drug use?:Yes
14. Have you ever lost friends because of your use of drugs?:No
15. Have you ever neglected your family or missed work because of your use of drugs?:Yes
16. Have you ever been in trouble at work because of drug abuse?:No
17. Have you ever lost a job because of drug abuse?:Yes
18. Have you gotten into fights when under the influence of drugs?:No
19. Have you ever been arrested because of unusual behavior while under the influence of drugs?:Yes
20. Have you ever been arrested for driving while under the influence of drugs?:No
21. Have you engaged in illegal activities in order to obtain drug?:Yes
22. Have you ever been arrested for possession of illegal drugs?:No
23. Have you ever experienced withdrawal symptoms as a result of heavy drug intake?:Yes
24. Have you had medical problems as a result of your drug use (e.g., memory loss, hepatitis, convulsions, bleeding, etc.)?:No
25. Have you ever gone to anyone for help for a drug problem?:Yes
26. Have you ever been in a hospital for medical problems related to your drug use?:No
27. Have you ever been involved in a treatment program specifically related to drug use?:Yes
28. Have you been treated as an outpatient for problems related to drug abuse?:No
DAST Score: 16
Diagnosis: Screen for substance use disorders
DAST Score: 16
Diagnosis: Screen for substance use disorders
  • navigate_next Create a HIPAA compliant DAST 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 DAST form responses to Google Sheets and sending them on email
  • navigate_next Prepopulate patient details in DAST 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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