Remote Patient Monitoring and Data Sharing Survey Template
Use this customizable survey template to measure patient comfort with remote patient monitoring (RPM) devices and health data sharing. Mobile-friendly.
What's Included
AI-Powered Questions
Intelligent follow-up questions based on responses
Automated Analysis
Real-time sentiment and insight detection
Smart Distribution
Target the right audience automatically
Detailed Reports
Comprehensive insights and recommendations
Sample Survey Items
Q1
Opinion Scale
Overall, how comfortable are you using remote health monitoring devices today?
Range: 1 – 10
Min: Not at all comfortableMid: NeutralMax: Very comfortable
Q2
Multiple Choice
In the last 6 months, have you used any remote health monitoring device?
Yes
No
Not sure
Q3
Multiple Choice
Which device(s) have you used in the last 6 months? Select all that apply.
Bluetooth blood pressure cuff
Continuous glucose monitor (CGM)
Finger pulse oximeter
Smartwatch or fitness tracker
Digital weight scale
ECG patch/monitor
Medication adherence device
Q4
Dropdown
In the last 30 days, how often did you use these device(s)? If you used more than one, think of the one you used most.
Daily
Several times per week
Once per week
2–3 times per month
Once
Not at all in the last 30 days
Q5
Multiple Choice
In the last 6 months, did you share data from any device with a clinician?
Yes
No
Not sure
Q6
Long Text
If you did not share data, what, if anything, kept you from sharing it with a clinician?
Max 600 chars
Q7
Rating
How willing are you to try a remote monitoring device in the next 3 months?
Scale: 10 (star)
Min: Not willingMax: Very willing
Q8
Matrix
How comfortable are you sharing remote monitoring data with each of the following?
Rows
Very uncomfortable
Uncomfortable
Neutral
Comfortable
Very comfortable
Primary care clinician
•
•
•
•
•
Specialist clinician
•
•
•
•
•
Family caregiver
•
•
•
•
•
Health insurer
•
•
•
•
•
Device manufacturer
•
•
•
•
•
Health app or technology company
•
•
•
•
•
Employer wellness program
•
•
•
•
•
Q9
Opinion Scale
How important is it for you to control which data are shared and with whom?
Range: 1 – 10
Min: Not importantMid: Moderately importantMax: Extremely important
Q10
Multiple Choice
Which concerns, if any, do you have about sharing remote monitoring data? Select all that apply.
Privacy or confidentiality
Data misuse or secondary use
Security/hacking risk
Insurance or employment discrimination
Data accuracy/reliability
Device is too complex
Battery/comfort/wearability
Internet or connectivity limits
Out-of-pocket cost
Other option allowed
Q11
Ranking
Please rank who you trust most to handle your device data (1=most trusted). Rank all options.
Drag to order (top = most important)
Your clinician
Hospital or health system
Health insurer
Device manufacturer
Large technology company
Government health agency
Q12
Multiple Choice
Which consent approach do you prefer for sharing device data?
One-time consent per provider/clinic
Granular consent by data type (e.g., steps, glucose)
Prompt me each time data are shared
Automatic sharing with the ability to revoke anytime
Not sure / no preference
Other option allowed
Q13
Opinion Scale
Using remote monitoring would help me manage my health.