Use our readymade template to create your Social Phobia Inventory (SPIN) screening tool for social anxiety disorder
Create your care assessments
| SPIN score | Symptom Severity | Proposed treatment |
|---|---|---|
| 0-20 | None | May not need treatment |
| 21-30 | Mild | Consider counseling |
| 31-40 | Moderate | Consider medication and therapy |
| 41-50 | Severe | Active treatment |
| 51-68 | Very Severe | Immediate initiation |
- Prebuilt template with SPIN scoring to assess the presence of social anxiety disorder and measure its severity
- 17-item questionnaire that scores each item from “0” (not at all) to “4” (extremely)
- Real-time calculation of SPIN Score and symptom severity 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 social anxiety disorder
- Easily create responsive forms that allow patients to complete their assessments on any device at any time
Collect responses from your patients
| Patient ID | 1005 |
| Patient Name | Jane D |
| Patient Email | janed@ymail.com |
| Patient Phone Number | 1234567890 |
| Doctor's Name | Dr. Smith |
| Location | New York |
| For each statement below, please select the answer that best describes how you have been feeling during the last week | |
| I am afraid of people in authority. | Very Much |
| I am bothered by blushing in front of people. | Somewhat |
| Parties and social events scare me. | A Little Bit |
| I avoid talking to people I don’t know. | Not At All |
| Being criticized scares me a lot. | Very Much |
| I avoid doing things or speaking to people for fear of embarrassment. | Extremely |
| Sweating in front of people causes me distress. | Somewhat |
| I avoid going to parties. | A Little Bit |
| I avoid activities in which I am the center of attention. | Very Much |
| Talking to strangers scares me. | Somewhat |
| I avoid having to give speeches. | Not At All |
| I would do anything to avoid being criticized. | Very Much |
| Heart palpitations bother me when I am around people. | Somewhat |
| I am afraid of doing things when people might be watching. | A Little Bit |
| Being embarrassed or looking stupid are among my worst fears. | Very Much |
| I avoid speaking to anyone in authority. | Somewhat |
| Trembling or shaking in front of others is distressing to me. | A Little Bit |
| SPIN Score | 38 |
| Symptom Severity | Moderate |
- Pre-populate patient details such as patient id, name, email etc in the SPIN assessment form before sharing it with the patients
- Send an email invitation with a secure link for patients to complete their SPIN assessment form prior to their visit
- Allow patients to save their progress and complete their SPIN assessment form at a later time without losing any responses
- Set up an email template for your SPIN assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their SPIN score, diagnosis, next steps when they submit their SPIN assessment
Track patient responses in Google Sheets
| A | B | C | D | E | |
|---|---|---|---|---|---|
| 1 | Name | Question | Answer | Score | Total Score |
| 2 | Jane D | I am afraid of people in authority. | Very Much | 3 | 38 |
| 3 | Jane D | I am bothered by blushing in front of people. | Somewhat | 2 | 38 |
| 4 | Jane D | Parties and social events scare me. | A Little Bit | 1 | 38 |
| 5 | Jane D | I avoid talking to people I don’t know. | Not At All | 0 | 38 |
| 6 | Jane D | Being criticized scares me a lot. | Very Much | 3 | 38 |
| 7 | Jane D | I avoid doing things or speaking to people for fear of embarrassment. | Extremely | 4 | 38 |
| 8 | Jane D | Sweating in front of people causes me distress. | Somewhat | 2 | 38 |
| 9 | Jane D | I avoid going to parties. | A Little Bit | 1 | 38 |
| 10 | Jane D | I avoid activities in which I am the center of attention. | Very Much | 3 | 38 |
| 11 | Jane D | Talking to strangers scares me. | Somewhat | 2 | 38 |
| 12 | Jane D | I avoid having to give speeches. | Not At All | 0 | 38 |
| 13 | Jane D | I would do anything to avoid being criticized. | Very Much | 3 | 38 |
| 14 | Jane D | Heart palpitations bother me when I am around people. | Somewhat | 2 | 38 |
| 15 | Jane D | I am afraid of doing things when people might be watching. | A Little Bit | 1 | 38 |
| 16 | Jane D | Being embarrassed or looking stupid are among my worst fears. | Very Much | 3 | 38 |
| 17 | Jane D | I avoid speaking to anyone in authority. | Somewhat | 2 | 38 |
| 18 | Jane D | Trembling or shaking in front of others is distressing to me. | A Little Bit | 1 | 38 |
- Export patient responses including the calculated SPIN score and symptom severity to Google Sheets for easy record-keeping
- Export individual points for 17 items 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 social anxiety symptoms
- Receive a copy of the response and the calculated SPIN score by email whenever a patient submits their SPIN assessment
- Use data in Google Sheets to integrate with external EHR systems for seamless data transfer
HIPAA compliance
| Patient ID: | 1005 |
| Patient Name: | ****** |
| Patient Email: | ****** |
| Patient Phone Number: | ****** |
| Doctor's Name: | Dr. Smith |
| Location: | New York |
| For each statement below, please select the answer that best describes how you have been feeling during the last week | |
| I am afraid of people in authority.: | Very Much |
| I am bothered by blushing in front of people.: | Somewhat |
| Parties and social events scare me.: | A Little Bit |
| I avoid talking to people I don’t know.: | Not At All |
| Being criticized scares me a lot.: | Very Much |
| I avoid doing things or speaking to people for fear of embarrassment.: | Extremely |
| Sweating in front of people causes me distress.: | Somewhat |
| I avoid going to parties.: | A Little Bit |
| I avoid activities in which I am the center of attention.: | Very Much |
| Talking to strangers scares me.: | Somewhat |
| I avoid having to give speeches.: | Not At All |
| I would do anything to avoid being criticized.: | Very Much |
| Heart palpitations bother me when I am around people.: | Somewhat |
| I am afraid of doing things when people might be watching.: | A Little Bit |
| Being embarrassed or looking stupid are among my worst fears.: | Very Much |
| I avoid speaking to anyone in authority.: | Somewhat |
| Trembling or shaking in front of others is distressing to me.: | A Little Bit |
| SPIN Score: | 38 |
| Symptom Severity: | Moderate |
| SPIN Score: | 38 |
| Symptom Severity: | Moderate |
- Create a HIPAA compliant SPIN 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 SPIN form responses to Google Sheets and sending them on email
- Prepopulate patient details in SPIN 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 23, 2023
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
Does not work
— Myles Sicuro
October 31, 2023
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
It very friendly to used. I love it. For my case multiple signature needed. it's supporting
— Senthil Kumar
November 27, 2023
Yeah this is good for all
— luqman Khan
July 10, 2023
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