Use our readymade template to create your Whiplash Disability Questionnaire (WDQ) for assessing the impact of whiplash injury on a patient's lifestyle
Create your care assessments
| WDQ score | Proposed treatment |
|---|---|
| 0-30 | Mild impact, may not need treatment |
| 31-70 | Moderate impact, consider therapy |
| 71-100 | Severe impact, immediate treatment |
- Prebuilt template with WDQ scoring to assess the presence of whiplash injury and measure its impact
- 13-item questionnaire that scores each item on a scale of 0 to 10
- Real-time calculation of WDQ Score based on the form responses
- Collect patient data and other sensitive healthcare data using our HIPAA compliant online assessment forms
- 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. How much pain do you have today? | 5 |
| 2. Do your whiplash symptoms interfere with your personal care (washing, dressing etc)? | 3 |
| 3. Do your whiplash symptoms interfere with your work/home/study duties? | 4 |
| 4. Do your whiplash symptoms interfere with driving or using public transport? | 2 |
| 5. Do your whiplash symptoms interfere with sleep? | 6 |
| 6. Do you feel more tired/fatigued than usual since your injury? | 5 |
| 7. Do your whiplash symptoms interfere with social activity? | 4 |
| 8. Do your whiplash symptoms interfere with sporting activity? | 3 |
| 9. Do your whiplash symptoms interfere with non-sporting leisure activity? | 2 |
| 10. Do you experience sadness/depression as a result of your whiplash injury/symptoms? | 1 |
| 11. Do you experience anger as a result of your whiplash injury/symptoms? | 2 |
| 12. Do you experience anxiety as a result of your whiplash injury/symptoms? | 3 |
| 13. Do you have difficulty concentrating as a result of your whiplash injury/symptoms? | 4 |
| WDQ Score | 44 |
- Pre-populate patient details such as patient id, name, email etc in the WDQ assessment form before sharing it with the patients
- Send an email invitation with a secure link for patients to complete their WDQ assessment form prior to their visit
- Allow patients to save their progress and complete their WDQ assessment form at a later time without losing any responses
- Set up an email template for your WDQ assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their WDQ score, diagnosis, next steps when they submit their WDQ assessment
Track patient responses in Google Sheets
| A | B | C | D | E | |
|---|---|---|---|---|---|
| 1 | Name | Question | Answer | Score | Total Score |
| 2 | John W | 1. How much pain do you have today? | 5 | 5 | 44 |
| 3 | John W | 2. Do your whiplash symptoms interfere with your personal care (washing, dressing etc)? | 3 | 3 | 44 |
| 4 | John W | 3. Do your whiplash symptoms interfere with your work/home/study duties? | 4 | 4 | 44 |
| 5 | John W | 4. Do your whiplash symptoms interfere with driving or using public transport? | 2 | 2 | 44 |
| 6 | John W | 5. Do your whiplash symptoms interfere with sleep? | 6 | 6 | 44 |
| 7 | John W | 6. Do you feel more tired/fatigued than usual since your injury? | 5 | 5 | 44 |
| 8 | John W | 7. Do your whiplash symptoms interfere with social activity? | 4 | 4 | 44 |
| 9 | John W | 8. Do your whiplash symptoms interfere with sporting activity? | 3 | 3 | 44 |
| 10 | John W | 9. Do your whiplash symptoms interfere with non-sporting leisure activity? | 2 | 2 | 44 |
| 11 | John W | 10. Do you experience sadness/depression as a result of your whiplash injury/symptoms? | 1 | 1 | 44 |
| 12 | John W | 11. Do you experience anger as a result of your whiplash injury/symptoms? | 2 | 2 | 44 |
| 13 | John W | 12. Do you experience anxiety as a result of your whiplash injury/symptoms? | 3 | 3 | 44 |
| 14 | John W | 13. Do you have difficulty concentrating as a result of your whiplash injury/symptoms? | 4 | 4 | 44 |
- Export patient responses including the calculated WDQ score to Google Sheets for easy record-keeping
- Export individual points for 13 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 whiplash symptoms
- Receive a copy of the response and the calculated WDQ score by email whenever a patient submits their WDQ 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: | ****** |
| Doctor's Name: | Dr. Smith |
| Location: | New York |
| 1. How much pain do you have today?: | 5 |
| 2. Do your whiplash symptoms interfere with your personal care (washing, dressing etc)?: | 3 |
| 3. Do your whiplash symptoms interfere with your work/home/study duties? : | 4 |
| 4. Do your whiplash symptoms interfere with driving or using public transport?: | 2 |
| 5. Do your whiplash symptoms interfere with sleep?: | 6 |
| 6. Do you feel more tired/fatigued than usual since your injury?: | 5 |
| 7. Do your whiplash symptoms interfere with social activity? : | 4 |
| 8. Do your whiplash symptoms interfere with sporting activity? : | 3 |
| 9. Do your whiplash symptoms interfere with non-sporting leisure activity?: | 2 |
| 10. Do you experience sadness/depression as a result of your whiplash injury/symptoms? : | 1 |
| 11. Do you experience anger as a result of your whiplash injury/symptoms? : | 2 |
| 12. Do you experience anxiety as a result of your whiplash injury/symptoms?: | 3 |
| 13. Do you have difficulty concentrating as a result of your whiplash injury/symptoms?: | 4 |
| WDQ Score: | 44 |
| WDQ Score: | 44 |
- Create a HIPAA compliant WDQ 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 WDQ form responses to Google Sheets and sending them on email
- Prepopulate patient details in WDQ 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
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