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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

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Detailed Reports

Comprehensive insights and recommendations

Sample Survey Items

Q1
opinion scale
Overall, how comfortable are you using remote health monitoring devices today?
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.
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?
Q8
matrix
How comfortable are you sharing remote monitoring data with each of the following?
Q9
opinion scale
How important is it for you to control which data are shared and with whom?
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
Q11
ranking
Please rank who you trust most to handle your device data (1=most trusted). Rank all options.
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
Q13
opinion scale
Using remote monitoring would help me manage my health.
Q14
multiple choice
What would help you use remote monitoring comfortably? Select all that apply.
  • Help setting up the device/app
  • Written step-by-step guide
  • Phone or chat support when needed
  • Training from clinic staff
  • Clear explanation of how data are used
  • Ability to pause/stop data collection easily
  • Cost assistance or device provided
  • None of the above
Q15
multiple choice
Attention check: To confirm you’re paying attention, please select "Blue" below.
  • Red
  • Blue
  • Green
  • Yellow
Q16
long text
Anything else you’d like to share about remote monitoring or data sharing?
Max 600 chars
Q17
dropdown
What is your age group?
Q18
multiple choice
How do you describe your gender?
  • Woman
  • Man
  • Non-binary
  • Prefer to self-describe
  • Prefer not to say
Q19
dropdown
What is the highest level of education you have completed?
Q20
multiple choice
What is your current employment status?
  • Employed full-time
  • Employed part-time
  • Self-employed
  • Unemployed and seeking work
  • Not working by choice (e.g., student, retired, caregiver)
  • Unable to work
  • Prefer not to say
Q21
dropdown
Where do you live most of the year?
Q22
multiple choice
How many times have you seen a healthcare professional in the last 12 months?
  • 0
  • 1–2
  • 3–5
  • 6–10
  • 11 or more
  • Prefer not to say
Q23
multiple choice
Do you have a smartphone you use at least weekly?
  • Yes
  • No
  • Prefer not to say
Q24
long text
Any final comments or feedback about this survey?
Max 600 chars
Q25
ai interview
AI Interview: 2 Follow-up Questions on Remote Monitoring and Data Sharing
AI Interview
Q26
chat message
Thank you for completing the survey! Your responses have been recorded.

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Remote Patient Monitoring and Data Sharing Survey Template - Survey Template | QuestionPunk