Örebro Musculoskeletal Pain Screening Questionnaire - Short Form
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Use our readymade template to create your OMPQ-10 screening tool for musculoskeletal pain

Create your care assessments

OMPQ-10 score Risk of long-term disability and work absenteeism
0-20 Low
21-50 Moderate
51-100 High
  • navigate_next Prebuilt template with OMPQ-10 scoring to assess the presence of musculoskeletal pain and predict long-term disability and work absenteeism
  • navigate_next 10-item questionnaire that scores each item from “0” to “10”
  • navigate_next Real-time calculation of OMPQ-10 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 musculoskeletal pain
  • navigate_next 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 long have you had your current pain problem? Over 1 year
2. How would you rate the pain that you have had during the past week? 10
3. I can do light work (or home duties) for an hour. 0
4. I can sleep at night. 0
5. How tense or anxious have you felt in the past week? 10
6. How much have you been bothered by feeling depressed in the past week? 10
7. In your view, how large is the risk that your current pain may become persistent? 10
8. In your estimation, what are the chances you will be working your normal duties (at home or work) in 3 months. 0
9. An increase in pain is an indication that I should stop what I’m doing until the pain decreases. 10
10. I should not do my normal work (at work or home duties) with my present pain. 10
OMPQ Score 100
  • navigate_next Collect patient details such as patient id, name, email etc in the OMPQ-10 assessment form
  • navigate_next Send an email invitation with a secure link for patients to complete their OMPQ-10 assessment form prior to their visit
  • navigate_next Allow patients to save their progress and complete their OMPQ-10 assessment form at a later time without losing any responses
  • navigate_next Set up an email template for your OMPQ-10 assessment and automatically send invitation emails to multiple patients with ease
  • navigate_next Send a confirmation email to the patients with their OMPQ-10 score, diagnosis, next steps when they submit their OMPQ-10 assessment

Track patient responses in Google Sheets

A B C D E
1 Name Question Answer Score Total Score
2 John W 1. How long have you had your current pain problem? Over 1 year 10 100
3 John W 2. How would you rate the pain that you have had during the past week? 10 10 100
4 John W 3. I can do light work (or home duties) for an hour. 0 10 100
5 John W 4. I can sleep at night. 0 10 100
6 John W 5. How tense or anxious have you felt in the past week? 10 10 100
7 John W 6. How much have you been bothered by feeling depressed in the past week? 10 10 100
8 John W 7. In your view, how large is the risk that your current pain may become persistent? 10 10 100
9 John W 8. In your estimation, what are the chances you will be working your normal duties (at home or work) in 3 months. 0 10 100
10 John W 9. An increase in pain is an indication that I should stop what I’m doing until the pain decreases. 10 10 100
11 John W 10. I should not do my normal work (at work or home duties) with my present pain. 10 10 100
  • navigate_next Export patient responses including the calculated OMPQ-10 score to Google Sheets for easy record-keeping
  • navigate_next Export individual points for 10 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 musculoskeletal pain symptoms
  • navigate_next Receive a copy of the response and the calculated OMPQ-10 score by email whenever a patient submits their OMPQ-10 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. How long have you had your current pain problem?: Over 1 year
2. How would you rate the pain that you have had during the past week?: 10
5. How tense or anxious have you felt in the past week?: 10
6. How much have you been bothered by feeling depressed in the past week?: 10
7. In your view, how large is the risk that your current pain may become persistent?: 10
9. An increase in pain is an indication that I should stop what I’m doing until the pain decreases. : 10
10. I should not do my normal work (at work or home duties) with my present pain.: 10
OMPQ Score: 100
OMPQ Score: 100
  • navigate_next Create a HIPAA compliant OMPQ-10 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 OMPQ-10 form responses to Google Sheets and sending them on email
  • navigate_next Prepopulate patient details in OMPQ-10 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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