Health Literacy Assessment Survey
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Health Literacy Assessment Survey
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The Health Literacy Assessment Survey provides a structured way to evaluate how well patients understand health information, follow medical instructions, and navigate the complexities of the healthcare system. Low health literacy affects an estimated one in three American adults and is independently associated with higher hospitalization rates, lower medication adherence, poorer chronic disease outcomes, and increased healthcare costs. Despite its prevalence and impact, health literacy is rarely assessed systematically in clinical practice, leaving providers unaware that their communication approach may not be reaching patients effectively.
This survey draws on validated health literacy screening approaches including the Single Item Literacy Screener (SILS), Newest Vital Sign (NVS) concepts, and Brief Health Literacy Screening (BHLS) questions. It assesses the patient's confidence reading medical materials, understanding prescription labels, filling out health forms independently, and comprehending numerical information such as lab results and dosage instructions. Additional items evaluate the patient's comfort asking questions during appointments, awareness of available patient education resources, and preferred formats for receiving health information (written, verbal, visual, video, or translated materials).
This template is valuable for community health centers, safety-net clinics, federally qualified health centers, and any practice serving diverse or underserved populations where language barriers, limited formal education, or cultural differences may affect health comprehension. Care coordinators and patient educators use the results to tailor discharge instructions, simplify medication regimens, recommend teach-back communication techniques, and connect patients with appropriate literacy support resources. By identifying health literacy gaps proactively, practices can reduce avoidable readmissions, improve medication adherence, and close health equity gaps in their patient population.
What's included
- Validated health literacy screening questions based on SILS and BHLS
- Reading, numeracy, and form comprehension self-assessment scales
- Comfort level with asking questions and engaging in care decisions
- Preferred health information format and language preference capture
- Patient education resource awareness evaluation
- Communication accommodation needs documentation
Who uses this template
- Community health centers assessing literacy levels in diverse patient populations
- Care coordinators tailoring discharge instructions to patient comprehension
- Federally qualified health centers addressing health equity and access barriers
- Patient education teams designing materials matched to audience literacy levels
All form fields
10 fields across 1 page. Customize any field after signing up.
How to use the Health Literacy Assessment Survey
Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the Health Literacy Assessment Survey from the template library. The form is ready to use immediately, but you can customize every field, add your practice logo, and adjust the layout to match your workflow.
Setup steps
- 1Choose the template. Find the Health Literacy Assessment Survey in the template library and click “Use this template” to add it to your account.
- 2Customize fields. Add, remove, or reorder any of the 10 fields. Set fields as required or optional based on your practice needs.
- 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
- 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
- 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.
Frequently asked questions
Is the Health Literacy Assessment Survey HIPAA compliant?
Yes. All Formisoft templates, including the Health Literacy Assessment Survey, are HIPAA compliant. Data is encrypted with 256-bit AES at rest and TLS 1.3 in transit. A Business Associate Agreement (BAA) is included on every plan.
Can I customize the fields in this template?
Absolutely. You can add, remove, reorder, or modify any of the 10 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.
How do patients fill out this form?
Patients receive a link via SMS, email, or QR code. They complete the form on their phone, tablet, or computer before their appointment. No app download required.
Can I send this form automatically before appointments?
Yes. Formisoft's workflow automation can send intake forms automatically when an appointment is booked. You can set the timing (e.g., 48 hours before the visit) and include reminders for patients who haven't completed it.
Does this template work on mobile devices?
Yes. The Health Literacy Assessment Survey is fully responsive and works on any device. Most patients complete intake forms on their phone, so every template is optimized for mobile-first use.
Start with this template
Sign up and start customizing the Health Literacy Assessment Survey for your practice. Set up in minutes.
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