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Use our readymade template to create your WHO Quality of Life (WHOQOL - BREF) assessment tool
Create your care assessments
- Prebuilt template with WHOQOL - BREF scoring to assess the quality of life
- 26-item questionnaire that scores each of the 26 criteria as “1” (very dissatisfied/very poor) to “5” (very satisfied/very good)
- Real-time calculation of WHOQOL - BREF Score 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 quality of life
- 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 |
| Gender | Male |
| Date of Birth | 1980-01-01 |
| Education | Graduate/Professional Degree |
| Marital Status | Single |
| Are you currently ill? | No |
| 1. How would you rate your quality of life? | Good |
| 2. How satisfied are you with your health? | Satisfied |
| 3. To what extent do you feel that physical pain prevents you from doing what you need to do? | Not at all |
| 4. How much do you need any medical treatment to function in your daily life? | Not at all |
| 5. How much do you enjoy life? | Very much |
| 6. To what extent do you feel your life to be meaningful? | Very much |
| 7. How well are you able to concentrate? | Extremely |
| 8. How safe do you feel in your daily life? | Very much |
| 9. How healthy is your physical environment? | Very much |
| 10. Do you have enough energy for everyday life? | Completely |
| 11. Are you able to accept your bodily appearance? | Completely |
| 12. Have you enough money to meet your needs? | Completely |
| 13. How available to you is the information that you need in your day-to-day life? | Completely |
| 14. To what extent do you have the opportunity for leisure activities? | Completely |
| 15. How well are you able to get around? | Very good |
| 16. How satisfied are you with your sleep? | Very satisfied |
| 17. How satisfied are you with your ability to perform your daily living activities? | Very satisfied |
| 18. How satisfied are you with your capacity for work? | Very satisfied |
| 19. How satisfied are you with yourself? | Very satisfied |
| 20. How satisfied are you with your personal relationships? | Very satisfied |
| 21. How satisfied are you with your sex life? | Very satisfied |
| 22. How satisfied are you with the support you get from your friends? | Very satisfied |
| 23. How satisfied are you with the conditions of your living place? | Very satisfied |
| 24. How satisfied are you with your access to health services? | Very satisfied |
| 25. How satisfied are you with your transport? | Very satisfied |
| 26. How often do you have negative feelings such as blue mood, despair, anxiety, depression? | Never |
- Pre-populate patient details such as patient id, name, email etc in the WHOQOL - BREF assessment form before sharing it with the patients
- Send an email invitation with a secure link for patients to complete their WHOQOL - BREF assessment form prior to their visit
- Allow patients to save their progress and complete their WHOQOL - BREF assessment form at a later time without losing any responses
- Set up an email template for your WHOQOL - BREF assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their WHOQOL - BREF score, diagnosis, next steps when they submit their WHOQOL - BREF assessment
Track patient responses in Google Sheets
| A | B | C | D | E | |
|---|---|---|---|---|---|
| 1 | Name | Question | Answer | Score | Total Score |
| 2 | John W | 1. How would you rate your quality of life? | Good | 4 | |
| 3 | John W | 2. How satisfied are you with your health? | Satisfied | 4 | |
| 4 | John W | 3. To what extent do you feel that physical pain prevents you from doing what you need to do? | Not at all | 5 | |
| 5 | John W | 4. How much do you need any medical treatment to function in your daily life? | Not at all | 5 | |
| 6 | John W | 5. How much do you enjoy life? | Very much | 4 | |
| 7 | John W | 6. To what extent do you feel your life to be meaningful? | Very much | 4 | |
| 8 | John W | 7. How well are you able to concentrate? | Extremely | 5 | |
| 9 | John W | 8. How safe do you feel in your daily life? | Very much | 4 | |
| 10 | John W | 9. How healthy is your physical environment? | Very much | 4 | |
| 11 | John W | 10. Do you have enough energy for everyday life? | Completely | 5 | |
| 12 | John W | 11. Are you able to accept your bodily appearance? | Completely | 5 | |
| 13 | John W | 12. Have you enough money to meet your needs? | Completely | 5 | |
| 14 | John W | 13. How available to you is the information that you need in your day-to-day life? | Completely | 5 | |
| 15 | John W | 14. To what extent do you have the opportunity for leisure activities? | Completely | 5 | |
| 16 | John W | 15. How well are you able to get around? | Very good | 5 | |
| 17 | John W | 16. How satisfied are you with your sleep? | Very satisfied | 5 | |
| 18 | John W | 17. How satisfied are you with your ability to perform your daily living activities? | Very satisfied | 5 | |
| 19 | John W | 18. How satisfied are you with your capacity for work? | Very satisfied | 5 | |
| 20 | John W | 19. How satisfied are you with yourself? | Very satisfied | 5 | |
| 21 | John W | 20. How satisfied are you with your personal relationships? | Very satisfied | 5 | |
| 22 | John W | 21. How satisfied are you with your sex life? | Very satisfied | 5 | |
| 23 | John W | 22. How satisfied are you with the support you get from your friends? | Very satisfied | 5 | |
| 24 | John W | 23. How satisfied are you with the conditions of your living place? | Very satisfied | 5 | |
| 25 | John W | 24. How satisfied are you with your access to health services? | Very satisfied | 5 | |
| 26 | John W | 25. How satisfied are you with your transport? | Very satisfied | 5 | |
| 27 | John W | 26. How often do you have negative feelings such as blue mood, despair, anxiety, depression? | Never | 5 |
- Export patient responses including the calculated WHOQOL - BREF score to Google Sheets for easy record-keeping
- Export individual points for 26 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 quality of life
- Receive a copy of the response and the calculated WHOQOL - BREF score by email whenever a patient submits their WHOQOL - BREF 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 |
| Gender: | Male |
| Date of Birth: | 1/1/1980 |
| Education: | Graduate/Professional Degree |
| Marital Status: | Single |
| Are you currently ill?: | No |
| 1. How would you rate your quality of life? : | Good |
| 2. How satisfied are you with your health?: | Satisfied |
| 3. To what extent do you feel that physical pain prevents you from doing what you need to do?: | Not at all |
| 4. How much do you need any medical treatment to function in your daily life?: | Not at all |
| 5. How much do you enjoy life?: | Very much |
| 6. To what extent do you feel your life to be meaningful?: | Very much |
| 7. How well are you able to concentrate?: | Extremely |
| 8. How safe do you feel in your daily life?: | Very much |
| 9. How healthy is your physical environment?: | Very much |
| 10. Do you have enough energy for everyday life?: | Completely |
| 11. Are you able to accept your bodily appearance?: | Completely |
| 12. Have you enough money to meet your needs?: | Completely |
| 13. How available to you is the information that you need in your day-to-day life?: | Completely |
| 14. To what extent do you have the opportunity for leisure activities?: | Completely |
| 15. How well are you able to get around?: | Very good |
| 16. How satisfied are you with your sleep?: | Very satisfied |
| 17. How satisfied are you with your ability to perform your daily living activities?: | Very satisfied |
| 18. How satisfied are you with your capacity for work?: | Very satisfied |
| 19. How satisfied are you with yourself?: | Very satisfied |
| 20. How satisfied are you with your personal relationships?: | Very satisfied |
| 21. How satisfied are you with your sex life?: | Very satisfied |
| 22. How satisfied are you with the support you get from your friends?: | Very satisfied |
| 23. How satisfied are you with the conditions of your living place?: | Very satisfied |
| 24. How satisfied are you with your access to health services?: | Very satisfied |
| 25. How satisfied are you with your transport?: | Very satisfied |
| 26. How often do you have negative feelings such as blue mood, despair, anxiety, depression?: | Never |
| Overall Quality of Life & General Health: |
- Create a HIPAA compliant WHOQOL - BREF 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 WHOQOL - BREF form responses to Google Sheets and sending them on email
- Prepopulate patient details in WHOQOL - BREF 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
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