Self report Leeds Assessment of Neuropathic Symptoms and Signs Scale
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Use our readymade template to create your Self-report Leeds Assessment of Neuropathic Symptoms and Signs Scale (S-LANSS) for assessing neuropathic pain

Create your care assessments

S-LANSS score Proposed treatment
0-11 Pain is unlikely to be neuropathic
12-24 Pain is likely to be neuropathic
  • navigate_next Prebuilt template with S-LANSS scoring to assess the presence of neuropathic pain
  • navigate_next 7-item questionnaire that scores each item based on the patient's response
  • navigate_next Real-time calculation of S-LANSS 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 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. In the area where you have pain, do you also have “pins and needles”, tingling or prickling sensations? YES – I get these sensations
2. Does the painful area change colour (perhaps look mottled or more red) when the pain is particularly bad? NO – The pain does not affect the colour of my skin
3. Does your pain make the affected skin abnormally sensitive to touch? Getting unpleasant sensations or pain when lightly stroking the skin might describe this. YES – My skin in that area is particularly sensitive to touch
4. Does your pain come on suddenly and in bursts for no apparent reason when you are completely still? Words like “electric shocks”, jumping and bursting might describe this. NO – My pain doesn’t really feel like this
5. In the area where you have pain, does your skin feel unusually hot like a burning pain? YES – I get burning pain often
6. Gently rub the painful area with your index finger and then rub a non-painful area (for example, an area of skin further away or on the opposite side from the painful area). How does this rubbing feel in the painful area? I feel discomfort, like pins and needles, tingling or burning in the painful area that is different from the non-painful area
7. Gently press on the painful area with your finger tip and then gently press in the same way onto a non-painful area (the same non-painful area that you chose in the last question). How does this feel in the painful area? I feel numbness or tenderness in the painful area that is different from the non-painful area
LANSS Score 16
  • navigate_next Collect patient details such as patient id, name, email etc in the S-LANSS assessment form
  • navigate_next Send an email invitation with a secure link for patients to complete their S-LANSS assessment form prior to their visit
  • navigate_next Allow patients to save their progress and complete their S-LANSS assessment form at a later time without losing any responses
  • navigate_next Set up an email template for your S-LANSS assessment and automatically send invitation emails to multiple patients with ease
  • navigate_next Send a confirmation email to the patients with their S-LANSS score, diagnosis, next steps when they submit their S-LANSS assessment

Track patient responses in Google Sheets

A B C D E
1 Name Question Answer Score Total Score
2 John W 1. In the area where you have pain, do you also have “pins and needles”, tingling or prickling sensations? YES – I get these sensations 5 16
3 John W 2. Does the painful area change colour (perhaps look mottled or more red) when the pain is particularly bad? NO – The pain does not affect the colour of my skin 0 16
4 John W 3. Does your pain make the affected skin abnormally sensitive to touch? Getting unpleasant sensations or pain when lightly stroking the skin might describe this. YES – My skin in that area is particularly sensitive to touch 3 16
5 John W 4. Does your pain come on suddenly and in bursts for no apparent reason when you are completely still? Words like “electric shocks”, jumping and bursting might describe this. NO – My pain doesn’t really feel like this 0 16
6 John W 5. In the area where you have pain, does your skin feel unusually hot like a burning pain? YES – I get burning pain often 1 16
7 John W 6. Gently rub the painful area with your index finger and then rub a non-painful area (for example, an area of skin further away or on the opposite side from the painful area). How does this rubbing feel in the painful area? I feel discomfort, like pins and needles, tingling or burning in the painful area that is different from the non-painful area 5 16
8 John W 7. Gently press on the painful area with your finger tip and then gently press in the same way onto a non-painful area (the same non-painful area that you chose in the last question). How does this feel in the painful area? I feel numbness or tenderness in the painful area that is different from the non-painful area 3 16
  • navigate_next Export patient responses including the calculated S-LANSS score to Google Sheets for easy record-keeping
  • navigate_next Export individual points for 7 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 neuropathic pain symptoms
  • navigate_next Receive a copy of the response and the calculated S-LANSS score by email whenever a patient submits their S-LANSS 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
1. In the area where you have pain, do you also have “pins and needles”, tingling or prickling sensations?: YES – I get these sensations
2. Does the painful area change colour (perhaps look mottled or more red) when the pain is particularly bad?: NO – The pain does not affect the colour of my skin
3. Does your pain make the affected skin abnormally sensitive to touch? Getting unpleasant sensations or pain when lightly stroking the skin might describe this.: YES – My skin in that area is particularly sensitive to touch
4. Does your pain come on suddenly and in bursts for no apparent reason when you are completely still? Words like “electric shocks”, jumping and bursting might describe this.: NO – My pain doesn’t really feel like this
5. In the area where you have pain, does your skin feel unusually hot like a burning pain?: YES – I get burning pain often
6. Gently rub the painful area with your index finger and then rub a non-painful area (for example, an area of skin further away or on the opposite side from the painful area). How does this rubbing feel in the painful area?: I feel discomfort, like pins and needles, tingling or burning in the painful area that is different from the non-painful area
7. Gently press on the painful area with your finger tip and then gently press in the same way onto a non-painful area (the same non-painful area that you chose in the last question). How does this feel in the painful area?: I feel numbness or tenderness in the painful area that is different from the non-painful area
LANSS Score: 16
LANSS Score: 16
  • navigate_next Create a HIPAA compliant S-LANSS 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 S-LANSS form responses to Google Sheets and sending them on email
  • navigate_next Prepopulate patient details in S-LANSS 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

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October 31, 2023

5 stars

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February 16, 2024

1 stars

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— Myles Sicuro

July 12, 2023

5 stars

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November 27, 2023

5 stars

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July 10, 2023

5 stars

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