Lower Extremity Functional Scale
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Use our readymade template to create your Lower Extremity Functional Scale (LEFS) for assessing patients with lower limb problems

Create your care assessments

LEFS score Severity
0-20 Severe
21-40 Moderate
41-60 Mild
61-80 Minimal
  • navigate_next Prebuilt template with LEFS scoring to assess the presence and severity of lower limb problems
  • navigate_next 20-item questionnaire that scores each item from “0” (Extreme Difficulty or Unable to Perform Activity) to “4” (No Difficulty)
  • navigate_next Real-time calculation of LEFS Score based on the form responses
  • navigate_next Collect patient data and other sensitive healthcare data using our HIPAA compliant online assessment forms
  • navigate_next Compare the scores from the initial screening with that of the followup to track the progression of lower limb problems

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. Any of usual work, housework or school activities. A Little Bit of Difficulty
2. Your usual hobbies, recreational or sporting activities. Moderate Difficulty
3. Getting into or out of the bath. No Difficulty
4. Walking between rooms. Quite a Bit of Difficulty
5. Putting on your shoes or socks. No Difficulty
6. Squatting. A Little Bit of Difficulty
7. Lifting an object, like a bag of groceries from the floor. Moderate Difficulty
8. Performing light activities around your home. No Difficulty
9. Performing heaving activities around your home. Quite a Bit of Difficulty
10. Getting into or out of a car. No Difficulty
11. Walking 2 blocks. A Little Bit of Difficulty
12. Walking a mile. Moderate Difficulty
13. Going up or down 10 stairs (about 1 flight of stairs). No Difficulty
14. Standing for 1 hour. Quite a Bit of Difficulty
15. Sitting for 1 hour. No Difficulty
16. Running on even ground. A Little Bit of Difficulty
17. Running on uneven ground. Moderate Difficulty
18. Making sharp turns while running fast. No Difficulty
19. Hopping. A Little Bit of Difficulty
20. Rolling over in bed. No Difficulty
LEFS Score 60
  • navigate_next Pre-populate patient details such as patient id, name, email etc in the LEFS assessment form before sharing it with the patients
  • navigate_next Send an email invitation with a secure link for patients to complete their LEFS assessment form prior to their visit
  • navigate_next Allow patients to save their progress and complete their LEFS assessment form at a later time without losing any responses
  • navigate_next Set up an email template for your LEFS assessment and automatically send invitation emails to multiple patients with ease
  • navigate_next Send a confirmation email to the patients with their LEFS score, diagnosis, next steps when they submit their LEFS assessment

Track patient responses in Google Sheets

A B C D E
1 Name Question Answer Score Total Score
2 John W 1. Any of usual work, housework or school activities. A Little Bit of Difficulty 3 60
3 John W 2. Your usual hobbies, recreational or sporting activities. Moderate Difficulty 2 60
4 John W 3. Getting into or out of the bath. No Difficulty 4 60
5 John W 4. Walking between rooms. Quite a Bit of Difficulty 1 60
6 John W 5. Putting on your shoes or socks. No Difficulty 4 60
7 John W 6. Squatting. A Little Bit of Difficulty 3 60
8 John W 7. Lifting an object, like a bag of groceries from the floor. Moderate Difficulty 2 60
9 John W 8. Performing light activities around your home. No Difficulty 4 60
10 John W 9. Performing heaving activities around your home. Quite a Bit of Difficulty 1 60
11 John W 10. Getting into or out of a car. No Difficulty 4 60
12 John W 11. Walking 2 blocks. A Little Bit of Difficulty 3 60
13 John W 12. Walking a mile. Moderate Difficulty 2 60
14 John W 13. Going up or down 10 stairs (about 1 flight of stairs). No Difficulty 4 60
15 John W 14. Standing for 1 hour. Quite a Bit of Difficulty 1 60
16 John W 15. Sitting for 1 hour. No Difficulty 4 60
17 John W 16. Running on even ground. A Little Bit of Difficulty 3 60
18 John W 17. Running on uneven ground. Moderate Difficulty 2 60
19 John W 18. Making sharp turns while running fast. No Difficulty 4 60
20 John W 19. Hopping. A Little Bit of Difficulty 3 60
21 John W 20. Rolling over in bed. No Difficulty 4 60
  • navigate_next Export patient responses including the calculated LEFS score to Google Sheets for easy record-keeping
  • navigate_next Export individual points for 20 items to Google Sheets for data manipulation and analysis for comprehensive insights
  • navigate_next Use pre-built reports to easily keep track of patient progress over time and monitor changes in their lower limb problems
  • navigate_next Receive a copy of the response and the calculated LEFS score by email whenever a patient submits their LEFS assessment
  • navigate_next 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. Any of usual work, housework or school activities.: A Little Bit of Difficulty
2. Your usual hobbies, recreational or sporting activities. : Moderate Difficulty
3. Getting into or out of the bath.: No Difficulty
4. Walking between rooms.: Quite a Bit of Difficulty
5. Putting on your shoes or socks.: No Difficulty
6. Squatting.: A Little Bit of Difficulty
7. Lifting an object, like a bag of groceries from the floor. : Moderate Difficulty
8. Performing light activities around your home.: No Difficulty
9. Performing heaving activities around your home.: Quite a Bit of Difficulty
10. Getting into or out of a car.: No Difficulty
11. Walking 2 blocks.: A Little Bit of Difficulty
12. Walking a mile.: Moderate Difficulty
13. Going up or down 10 stairs (about 1 flight of stairs).: No Difficulty
14. Standing for 1 hour.: Quite a Bit of Difficulty
15. Sitting for 1 hour.: No Difficulty
16. Running on even ground.: A Little Bit of Difficulty
17. Running on uneven ground.: Moderate Difficulty
18. Making sharp turns while running fast.: No Difficulty
19. Hopping.: A Little Bit of Difficulty
20. Rolling over in bed.: No Difficulty
LEFS Score: 60
LEFS Score: 60
  • navigate_next Create a HIPAA compliant LEFS assessment form to safely collect, store and access patient responses
  • navigate_next Mark fields as Protected Health Information (PHI) to secure sensitive patient data and limit access to PHI
  • navigate_next Automatically mask PHI fields when exporting LEFS form responses to Google Sheets and sending them on email
  • navigate_next Prepopulate patient details in LEFS assessments by creating secure prefill links without exposing PHI
  • navigate_next 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 27, 2023

5 stars

I am 100% a fan of this company. We use HIPAA compliant Google Forms and needed a way to collect signatures, the industry standard company is TOO expensive. I started using FormEsign and it worked perfectly. It lacked the ability to provide a pdf copy of the form after signature. This company worked with me help their product evolve into something that could benefit all future clients AND the end user. The team was polite, professional, kind, enthusiastic, and willing to make a change. This earned my loyalty. I will sing their praises. Good work, and thank you!

— Royal Bush

July 23, 2023

5 stars

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

1 stars

Does not work

— Myles Sicuro

October 31, 2023

5 stars

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

5 stars

It very friendly to used. I love it. For my case multiple signature needed. it's supporting

— Senthil Kumar

November 27, 2023

5 stars

Yeah this is good for all

— luqman khan

July 10, 2023

5 stars

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

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