Functional Outcomes of Sleep Questionnaire
22 reviews
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Use our readymade template to create your FOSQ-10 screening tool for assessing the impact of sleep disorders on daily activities

Create your care assessments

Assessment form builder
  • navigate_next Prebuilt template with FOSQ-10 scoring to assess the impact of sleep disorders on daily activities
  • navigate_next 10-item questionnaire that scores each item from “1” (Yes, extreme) to “4” (No)
  • navigate_next Real-time calculation of FOSQ-10 Score 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 sleep 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
Select the appropriate answer for each statement
Do you have difficulty concentrating on the things you do because you are sleepy or tired? Yes, a little
Do you generally have difficulty remembering things, because you are sleepy or tired? No
Do you have difficulty finishing a meal because you become sleepy or tired? Yes, moderate
Do you have difficulty working on a hobby (for example, sewing, collecting, gardening) because you are sleepy or tired? Yes, extreme
Do you have difficulty doing work around the house (for example, cleaning house, doing laundry, taking out the trash, repair work) because you are sleepy or tired? Yes, a little
Do you have difficulty operating a motor vehicle for short distances (less than 100 miles) because you become sleepy or tired? No
Do you have difficulty operating a motor vehicle for long distances (greater than 100 miles) because you become sleepy or tired? Yes, moderate
Do you have difficulty getting things done because you are too sleepy or tired to drive or take public transportation? Yes, a little
Do you have difficulty taking care of financial affairs and doing paperwork (for example, writing checks, paying bills, keeping financial records, filling out tax forms, etc.) because you are sleepy or tired? No
Do you have difficulty performing employed or volunteer work because you are sleepy or tired? Yes, extreme
FOSQ-10 Score 30
  • navigate_next Collect patient details such as patient id, name, email etc in the FOSQ-10 assessment form
  • navigate_next Send an email invitation with a secure link for patients to complete their FOSQ-10 assessment form prior to their visit
  • navigate_next Allow patients to save their progress and complete their FOSQ-10 assessment form at a later time without losing any responses
  • navigate_next Set up an email template for your FOSQ-10 assessment and automatically send invitation emails to multiple patients with ease
  • navigate_next Send a confirmation email to the patients with their FOSQ-10 score, diagnosis, next steps when they submit their FOSQ-10 assessment

Track patient responses in Google Sheets

A B C D E
1 Name Question Answer Score Total Score
2 John W Do you have difficulty concentrating on the things you do because you are sleepy or tired? Yes, a little 3 30
3 John W Do you generally have difficulty remembering things, because you are sleepy or tired? No 4 30
4 John W Do you have difficulty finishing a meal because you become sleepy or tired? Yes, moderate 2 30
5 John W Do you have difficulty working on a hobby (for example, sewing, collecting, gardening) because you are sleepy or tired? Yes, extreme 1 30
6 John W Do you have difficulty doing work around the house (for example, cleaning house, doing laundry, taking out the trash, repair work) because you are sleepy or tired? Yes, a little 3 30
7 John W Do you have difficulty operating a motor vehicle for short distances (less than 100 miles) because you become sleepy or tired? No 4 30
8 John W Do you have difficulty operating a motor vehicle for long distances (greater than 100 miles) because you become sleepy or tired? Yes, moderate 2 30
9 John W Do you have difficulty getting things done because you are too sleepy or tired to drive or take public transportation? Yes, a little 3 30
10 John W Do you have difficulty taking care of financial affairs and doing paperwork (for example, writing checks, paying bills, keeping financial records, filling out tax forms, etc.) because you are sleepy or tired? No 4 30
11 John W Do you have difficulty performing employed or volunteer work because you are sleepy or tired? Yes, extreme 1 30
  • navigate_next Export patient responses including the calculated FOSQ-10 score 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 sleep disorder symptoms
  • navigate_next Receive a copy of the response and the calculated FOSQ-10 score by email whenever a patient submits their FOSQ-10 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
Select the appropriate answer for each statement
Do you have difficulty concentrating on the things you do because you are sleepy or tired?:Yes, a little
Do you generally have difficulty remembering things, because you are sleepy or tired?:No
Do you have difficulty finishing a meal because you become sleepy or tired?:Yes, moderate
Do you have difficulty working on a hobby (for example, sewing, collecting, gardening) because you are sleepy or tired?:Yes, extreme
Do you have difficulty doing work around the house (for example, cleaning house, doing laundry, taking out the trash, repair work) because you are sleepy or tired?:Yes, a little
Do you have difficulty operating a motor vehicle for short distances (less than 100 miles) because you become sleepy or tired?:No
Do you have difficulty operating a motor vehicle for long distances (greater than 100 miles) because you become sleepy or tired?:Yes, moderate
Do you have difficulty getting things done because you are too sleepy or tired to drive or take public transportation?:Yes, a little
Do you have difficulty taking care of financial affairs and doing paperwork (for example, writing checks, paying bills, keeping financial records, filling out tax forms, etc.) because you are sleepy or tired?:No
Do you have difficulty performing employed or volunteer work because you are sleepy or tired?:Yes, extreme
FOSQ-10 Score: 30
FOSQ-10 Score: 30
  • navigate_next Create a HIPAA compliant FOSQ-10 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 FOSQ-10 form responses to Google Sheets and sending them on email
  • navigate_next Collect patient details in FOSQ-10 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 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 31, 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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