Use our readymade template to create your WHO Quality of Life (WHOQOL - BREF) assessment tool
Create your care assessments
- Prebuilt template with WHOQOL - BREF scoring to assess the quality of life
- 26-item questionnaire that scores each of the 26 criteria as “1” (very dissatisfied/very poor) to “5” (very satisfied/very good)
- Real-time calculation of WHOQOL - BREF 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 quality of life
- 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 |
| Gender | Male |
| Date of Birth | 1980-01-01 |
| Education | Graduate/Professional Degree |
| Marital Status | Single |
| Are you currently ill? | No |
| 1. How would you rate your quality of life? | Good |
| 2. How satisfied are you with your health? | Satisfied |
| 3. To what extent do you feel that physical pain prevents you from doing what you need to do? | Not at all |
| 4. How much do you need any medical treatment to function in your daily life? | Not at all |
| 5. How much do you enjoy life? | Very much |
| 6. To what extent do you feel your life to be meaningful? | Very much |
| 7. How well are you able to concentrate? | Extremely |
| 8. How safe do you feel in your daily life? | Very much |
| 9. How healthy is your physical environment? | Very much |
| 10. Do you have enough energy for everyday life? | Completely |
| 11. Are you able to accept your bodily appearance? | Completely |
| 12. Have you enough money to meet your needs? | Completely |
| 13. How available to you is the information that you need in your day-to-day life? | Completely |
| 14. To what extent do you have the opportunity for leisure activities? | Completely |
| 15. How well are you able to get around? | Very good |
| 16. How satisfied are you with your sleep? | Very satisfied |
| 17. How satisfied are you with your ability to perform your daily living activities? | Very satisfied |
| 18. How satisfied are you with your capacity for work? | Very satisfied |
| 19. How satisfied are you with yourself? | Very satisfied |
| 20. How satisfied are you with your personal relationships? | Very satisfied |
| 21. How satisfied are you with your sex life? | Very satisfied |
| 22. How satisfied are you with the support you get from your friends? | Very satisfied |
| 23. How satisfied are you with the conditions of your living place? | Very satisfied |
| 24. How satisfied are you with your access to health services? | Very satisfied |
| 25. How satisfied are you with your transport? | Very satisfied |
| 26. How often do you have negative feelings such as blue mood, despair, anxiety, depression? | Never |
- Pre-populate patient details such as patient id, name, email etc in the WHOQOL - BREF assessment form before sharing it with the patients
- Send an email invitation with a secure link for patients to complete their WHOQOL - BREF assessment form prior to their visit
- Allow patients to save their progress and complete their WHOQOL - BREF assessment form at a later time without losing any responses
- Set up an email template for your WHOQOL - BREF assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their WHOQOL - BREF score, diagnosis, next steps when they submit their WHOQOL - BREF assessment
Track patient responses in Google Sheets
| A | B | C | D | E | |
|---|---|---|---|---|---|
| 1 | Name | Question | Answer | Score | Total Score |
| 2 | John W | 1. How would you rate your quality of life? | Good | 4 | |
| 3 | John W | 2. How satisfied are you with your health? | Satisfied | 4 | |
| 4 | John W | 3. To what extent do you feel that physical pain prevents you from doing what you need to do? | Not at all | 5 | |
| 5 | John W | 4. How much do you need any medical treatment to function in your daily life? | Not at all | 5 | |
| 6 | John W | 5. How much do you enjoy life? | Very much | 4 | |
| 7 | John W | 6. To what extent do you feel your life to be meaningful? | Very much | 4 | |
| 8 | John W | 7. How well are you able to concentrate? | Extremely | 5 | |
| 9 | John W | 8. How safe do you feel in your daily life? | Very much | 4 | |
| 10 | John W | 9. How healthy is your physical environment? | Very much | 4 | |
| 11 | John W | 10. Do you have enough energy for everyday life? | Completely | 5 | |
| 12 | John W | 11. Are you able to accept your bodily appearance? | Completely | 5 | |
| 13 | John W | 12. Have you enough money to meet your needs? | Completely | 5 | |
| 14 | John W | 13. How available to you is the information that you need in your day-to-day life? | Completely | 5 | |
| 15 | John W | 14. To what extent do you have the opportunity for leisure activities? | Completely | 5 | |
| 16 | John W | 15. How well are you able to get around? | Very good | 5 | |
| 17 | John W | 16. How satisfied are you with your sleep? | Very satisfied | 5 | |
| 18 | John W | 17. How satisfied are you with your ability to perform your daily living activities? | Very satisfied | 5 | |
| 19 | John W | 18. How satisfied are you with your capacity for work? | Very satisfied | 5 | |
| 20 | John W | 19. How satisfied are you with yourself? | Very satisfied | 5 | |
| 21 | John W | 20. How satisfied are you with your personal relationships? | Very satisfied | 5 | |
| 22 | John W | 21. How satisfied are you with your sex life? | Very satisfied | 5 | |
| 23 | John W | 22. How satisfied are you with the support you get from your friends? | Very satisfied | 5 | |
| 24 | John W | 23. How satisfied are you with the conditions of your living place? | Very satisfied | 5 | |
| 25 | John W | 24. How satisfied are you with your access to health services? | Very satisfied | 5 | |
| 26 | John W | 25. How satisfied are you with your transport? | Very satisfied | 5 | |
| 27 | John W | 26. How often do you have negative feelings such as blue mood, despair, anxiety, depression? | Never | 5 |
- Export patient responses including the calculated WHOQOL - BREF score to Google Sheets for easy record-keeping
- Export individual points for 26 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 quality of life
- Receive a copy of the response and the calculated WHOQOL - BREF score by email whenever a patient submits their WHOQOL - BREF 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 |
| Gender: | Male |
| Date of Birth: | 1/1/1980 |
| Education: | Graduate/Professional Degree |
| Marital Status: | Single |
| Are you currently ill?: | No |
| 1. How would you rate your quality of life? : | Good |
| 2. How satisfied are you with your health?: | Satisfied |
| 3. To what extent do you feel that physical pain prevents you from doing what you need to do?: | Not at all |
| 4. How much do you need any medical treatment to function in your daily life?: | Not at all |
| 5. How much do you enjoy life?: | Very much |
| 6. To what extent do you feel your life to be meaningful?: | Very much |
| 7. How well are you able to concentrate?: | Extremely |
| 8. How safe do you feel in your daily life?: | Very much |
| 9. How healthy is your physical environment?: | Very much |
| 10. Do you have enough energy for everyday life?: | Completely |
| 11. Are you able to accept your bodily appearance?: | Completely |
| 12. Have you enough money to meet your needs?: | Completely |
| 13. How available to you is the information that you need in your day-to-day life?: | Completely |
| 14. To what extent do you have the opportunity for leisure activities?: | Completely |
| 15. How well are you able to get around?: | Very good |
| 16. How satisfied are you with your sleep?: | Very satisfied |
| 17. How satisfied are you with your ability to perform your daily living activities?: | Very satisfied |
| 18. How satisfied are you with your capacity for work?: | Very satisfied |
| 19. How satisfied are you with yourself?: | Very satisfied |
| 20. How satisfied are you with your personal relationships?: | Very satisfied |
| 21. How satisfied are you with your sex life?: | Very satisfied |
| 22. How satisfied are you with the support you get from your friends?: | Very satisfied |
| 23. How satisfied are you with the conditions of your living place?: | Very satisfied |
| 24. How satisfied are you with your access to health services?: | Very satisfied |
| 25. How satisfied are you with your transport?: | Very satisfied |
| 26. How often do you have negative feelings such as blue mood, despair, anxiety, depression?: | Never |
| Overall Quality of Life & General Health: |
- Create a HIPAA compliant WHOQOL - BREF 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 WHOQOL - BREF form responses to Google Sheets and sending them on email
- Prepopulate patient details in WHOQOL - BREF 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