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Template library · Assessments & screeners

Insomnia Severity Index template

Adapted from the Insomnia Severity Index (ISI), ready to send to a client and keep on their record in MyWellOps.

  • 17 fields across 3 sections
  • Included with MyWellOps
  • Edit it, or save your own version

What’s in it

This is a published measure, so its questions are shown here by their shape rather than word for word. In MyWellOps the full measure is ready to send.

Assessment Details

  • Client NameText
  • Date of BirthDate
  • Client ID / MRNText
  • Date of AssessmentDate
  • Clinician / CoachText
  • Location / ModalityText

Sleep Difficulty

7 items, each answered: None · Mild · Moderate · Severe

Signatures

  • Clinician SignatureSignature
  • Date signed (clinician)Date
  • Client SignatureSignature
  • Date signed (client)Date

When to use it

Use an assessment at the start of work to set a baseline, then repeat it at review points so you and the client can see what has changed.

How it works in MyWellOps

  1. Pick it from Documents.
  2. Send it to the client to complete, or fill it in together during a session.
  3. Each completed copy is kept on the client’s record, so earlier results are there to compare.

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