formisoft

Epworth Sleepiness Scale

Asks about sitting and reading, watching television, and sitting inactive in a public place. Built for sleep medicine clinic initial evaluation.

Questions
12
Pages
2
Time
about 3 min
Use this templatePrint it instead

Your practice

Epworth Sleepiness Scale

Page 1 of 2 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • Sleep medicine clinic initial evaluation
  • Primary care fatigue and sleepiness complaints
  • CPAP therapy and sleep treatment outcome monitoring
  • Occupational health fitness-for-duty screening

Formisoft for Mental Health

What's inside

Before you publish: Clinical review required: this worksheet does not calculate scores, diagnose, or recommend treatment. Confirm the questions and response options against your approved assessment protocol before use.

Page 1 · Your information

  1. Patient NameText · Required
  2. Date of BirthDate
  3. Sitting and ReadingLong Text
  4. Watching TelevisionLong Text
  5. Sitting Inactive in a Public PlaceLong Text

Page 2 · Additional details

  1. Lying Down to Rest in AfternoonLong Text
  2. Sitting and Talking to SomeoneLong Text
  3. Sitting Quietly After LunchLong Text
  4. In a Car While Stopped in TrafficLong Text
  5. ESS Total ScoreNumber

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the Epworth Sleepiness Scale, and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

    03

    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

Related templates

All templates

Questions

Formisoft provides secure form collection and a Business Associate Agreement (BAA). Your practice must review the form content, access permissions, and sharing workflow for its requirements.

Yes. You can add, remove, reorder, or reword any of the 12 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Patients open a secure link from an email, a text, or a QR code and complete the form on their phone, tablet, or computer before their appointment. No app download required.

Yes, on Front Desk. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Yes. The Epworth Sleepiness Scale works on any device. Most patients complete intake forms on their phone, so every template is built for small screens first.

Send it before the visit, so patients arrive ready.

Add the Epworth Sleepiness Scale to your account and make it yours in a few minutes.

Cancel anytime · BAA included

Use this templateBook a demo