Use our readymade template to create your Insomnia Severity Index (ISI) screening tool for insomnia
Create your care assessments
| ISI score | Insomnia Level | Proposed treatment |
|---|---|---|
| 0-7 | No clinically significant insomnia | May not need treatment |
| 8-14 | Subthreshold insomnia | Watchful waiting |
| 15-21 | Clinical insomnia (moderate severity) | Consider counseling |
| 22-28 | Clinical insomnia (severe) | Active treatment |
- Prebuilt template with ISI scoring to assess the presence of insomnia and measure its severity
- 7-item questionnaire that scores each of the 7 criteria as “0” (None) to “4” (Very Severe)
- Real-time calculation of ISI Score and insomnia level 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 insomnia
- 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 |
| Please rate the CURRENT (i.e. LAST 2 WEEKS) SEVERITY of your insomnia problem(s). | |
| Difficulty falling asleep | Moderate |
| Difficulty staying asleep | Severe |
| Problems waking up too early | Very Severe |
| How SATISFIED/DISSATISFIED are you with your CURRENT sleep pattern? | Dissatisfied |
| How NOTICEABLE to others do you think your sleep problem is in terms of impairing the quality of your life? | Much |
| How WORRIED/DISTRESSED are you about your current sleep problem | Very Much Noticeable |
| To what extent do you consider your sleep problem to INTERFERE with your daily functioning (e.g. daytime fatigue, mood, ability to function at work/daily chores, concentration, memory, mood, etc.) CURRENTLY? | Very Much Interfering |
| ISI Score | 23 |
| Insomnia Level | Clinical insomnia (severe) |
- Pre-populate patient details such as patient id, name, email etc in the ISI assessment form before sharing it with the patients
- Send an email invitation with a secure link for patients to complete their ISI assessment form prior to their visit
- Allow patients to save their progress and complete their ISI assessment form at a later time without losing any responses
- Set up an email template for your ISI assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their ISI score, diagnosis, next steps when they submit their ISI assessment
Track patient responses in Google Sheets
| A | B | C | D | E | |
|---|---|---|---|---|---|
| 1 | Name | Question | Answer | Score | Total Score |
| 2 | John W | Difficulty falling asleep | Moderate | 2 | 23 |
| 3 | John W | Difficulty staying asleep | Severe | 3 | 23 |
| 4 | John W | Problems waking up too early | Very Severe | 4 | 23 |
| 5 | John W | How SATISFIED/DISSATISFIED are you with your CURRENT sleep pattern? | Dissatisfied | 3 | 23 |
| 6 | John W | How NOTICEABLE to others do you think your sleep problem is in terms of impairing the quality of your life? | Much | 3 | 23 |
| 7 | John W | How WORRIED/DISTRESSED are you about your current sleep problem | Very Much Noticeable | 4 | 23 |
| 8 | John W | To what extent do you consider your sleep problem to INTERFERE with your daily functioning (e.g. daytime fatigue, mood, ability to function at work/daily chores, concentration, memory, mood, etc.) CURRENTLY? | Very Much Interfering | 4 | 23 |
- Export patient responses including the calculated ISI score and insomnia level to Google Sheets for easy record-keeping
- Export individual points for 7 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 insomnia symptoms
- Receive a copy of the response and the calculated ISI score by email whenever a patient submits their ISI 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: | ****** |
| Please rate the CURRENT (i.e. LAST 2 WEEKS) SEVERITY of your insomnia problem(s). | |
| Difficulty falling asleep: | Moderate |
| Difficulty staying asleep: | Severe |
| Problems waking up too early: | Very Severe |
| How SATISFIED/DISSATISFIED are you with your CURRENT sleep pattern?: | Dissatisfied |
| How NOTICEABLE to others do you think your sleep problem is in terms of impairing the quality of your life?: | Much |
| How WORRIED/DISTRESSED are you about your current sleep problem : | Very Much Noticeable |
| To what extent do you consider your sleep problem to INTERFERE with your daily functioning (e.g. daytime fatigue, mood, ability to function at work/daily chores, concentration, memory, mood, etc.) CURRENTLY?: | Very Much Interfering |
| ISI Score: | 23 |
| Insomnia Level: | Clinical insomnia (severe) |
| ISI Score: | 23 |
| Insomnia Level: | Clinical insomnia (severe) |
- Create a HIPAA compliant ISI 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 ISI form responses to Google Sheets and sending them on email
- Prepopulate patient details in ISI 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
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July 23, 2023
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February 16, 2024
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October 31, 2023
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