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Healthcare & Clinical

Patient Comfort with Remote Monitoring & Data Sharing

Measures patient experience with remote patient monitoring (RPM) devices, comfort with health data sharing across stakeholders, trust and consent preferences, and support needs for adoption.

Sample questions

A preview of what’s in the template. Every question is editable before you launch.

27 questions · ~12 min
Q01
Message

Welcome to this survey about remote health monitoring devices and health data sharing. This survey takes approximately 8–10 minutes. Your participation is voluntary and you may stop at any time. There are no right or wrong answers—we are interested in your honest opinions and experiences. Your responses are confidential, will be anonymized, and reported only in aggregate. Results will be used to improve remote health monitoring programs and policies. By continuing, you agree to participate.

Q02
Multiple Choice

In the last 6 months, have you used any remote health monitoring device (e.g., blood pressure cuff, glucose monitor, smartwatch)?

  • Yes
  • No
  • Not sure
Q03
Opinion Scale

Overall, how comfortable are you with using remote health monitoring devices?

Scale: 17
Min:Not at all comfortableMax:Extremely comfortable
Q04
Opinion Scale

How comfortable are you sharing remote monitoring data with your personal healthcare provider?

Scale: 17
Min:Not at all comfortableMax:Extremely comfortable
Q05
Multiple Choice

Which of the following would help you use remote monitoring more comfortably? Select all that apply.

  • Help setting up the device or 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 or stop data collection easily
  • Cost assistance or device provided at no cost
  • None of the above
Q06
AI Interview

Based on your responses in this survey, please share any additional thoughts or feelings about remote health monitoring or health data sharing.

Q07
Dropdown

What is your age group?

  • 18–24
  • 25–34
  • 35–44
  • 45–54
  • 55–64
  • 65–74
  • 75+
  • Prefer not to say
Q08
Message

Thank you for completing this survey. Your responses are confidential and will be used to improve remote health monitoring experiences. We appreciate your time.

Q09
Multiple Choice

Which of the following devices 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 or monitor
  • Medication adherence device
  • Other (please specify)
Q10
Opinion Scale

To what extent do you agree or disagree: Using remote monitoring would help me manage my health.

Scale: 17
Min:Strongly disagreeMax:Strongly agree
Q11
Opinion Scale

How comfortable are you sharing remote monitoring data with a hospital or health system?

Scale: 17
Min:Not at all comfortableMax:Extremely comfortable
Q12
Multiple Choice

How do you describe your gender?

  • Woman
  • Man
  • Non-binary
  • Prefer to self-describe
  • Prefer not to say
Q13
Dropdown

Thinking about the device you used most often, how frequently did you use it in the last 30 days?

  • Daily
  • Several times per week
  • Once per week
  • 2–3 times per month
  • Once
  • Not at all in the last 30 days
Q14
Opinion Scale

How willing are you to use a remote monitoring device in the next 3 months?

Scale: 17
Min:Not at all willingMax:Extremely willing
Q15
Opinion Scale

How comfortable are you sharing remote monitoring data with your health insurer?

Scale: 17
Min:Not at all comfortableMax:Extremely comfortable
Q16
Dropdown

What is the highest level of education you have completed?

  • Less than high school
  • High school or equivalent
  • Some college or associate degree
  • Bachelor's degree
  • Graduate or professional degree
  • Prefer not to say
Q17
Multiple Choice

In the last 6 months, did you share data from any of these devices with a healthcare provider?

  • Yes
  • No
  • Not sure
Q18
Opinion Scale

How comfortable are you sharing remote monitoring data with the device manufacturer or a technology company?

Scale: 17
Min:Not at all comfortableMax:Extremely comfortable
Q19
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
Q20
Long Text

What, if anything, kept you from sharing your device data with a healthcare provider?

Q21
Opinion Scale

How important is it to you to control which health data are shared and with whom?

Scale: 17
Min:Not at all importantMax:Extremely important
Q22
Dropdown

Where do you live most of the year?

  • United States
  • Canada
  • United Kingdom
  • European Union
  • Australia / New Zealand
  • Other / Another region
  • Prefer not to say
Q23
Multiple Choice

Which of the following concerns, if any, do you have about sharing remote monitoring data? Select all that apply.

  • Privacy or confidentiality
  • Data misuse or secondary use
  • Security or hacking risk
  • Insurance or employment discrimination
  • Data accuracy or reliability
  • Internet or connectivity limitations
  • Out-of-pocket cost
  • Other (please specify)
  • None of the above
Q24
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
Q25
Ranking

Please rank the following from most trusted to least trusted to handle your health device data.

  1. Your healthcare provider
  2. Hospital or health system
  3. Health insurer
  4. Device manufacturer
  5. Large technology company
  6. Government health agency
Drag to rank
Q26
Multiple Choice

Do you have a smartphone you use at least weekly?

  • Yes
  • No
  • Prefer not to say
Q27
Multiple Choice

Which consent approach would you prefer for sharing your device data?

  • One-time consent per provider or 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

What’s included

  • AI follow-ups

    Adaptive probes on open-ended answers that pull out detail a static form would miss.

  • Attention checks

    Built-in safeguards against rushed answers and low-quality respondents.

  • AI-drafted copy

    Wording, ordering, and branching written by the AI — tuned to your research goal.

  • Auto report

    Themes, quotes, and a plain-English summary write themselves once responses come in.

How it compares

We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.

Why this template

  • Combines usage/behavior questions (device types, frequency, sharing history) with attitudinal measures across four distinct stakeholders (personal doctor, hospital/health system, insurer, device manufacturer), so comfort levels aren't treated as one-size-fits-all
  • Includes a ranking question on trust across data recipients plus a dedicated consent-approach question, giving both relative trust ordering and preferred consent mechanics in one flow
  • Uses an AI follow-up interview at the end to let respondents elaborate in their own words on any concerns or context behind their ratings, with transparent prompts rather than a black-box script
  • Captures barriers to sharing (open-text) and concrete adoption enablers (multi-select) so results are actionable for product/policy teams, not just descriptive

Jotform

Remote Patient Monitoring Form Template

A static form template focused on RPM data intake/logging (e.g., device readings, patient info) rather than attitudinal research into comfort, trust, or consent preferences. Useful as a clinical intake form but not built as a survey instrument measuring perception or willingness to share data. No mention of follow-up probing or scoring of responses.

What it does well

  • Purpose-built around remote patient monitoring workflows
  • Likely offers standard Jotform form-building features (fields, conditional logic, file upload)
  • Familiar drag-and-drop builder for quick customization

Where it falls short

  • Appears oriented to data collection/intake rather than measuring comfort, trust, or consent attitudes
  • No adaptive AI follow-up interview or voice interview option to probe reasoning behind answers
  • No indication of automated per-response quality scoring or transparent prompt methodology

SurveySparrow

Patient Consent Form Template

A consent-capture form template, likely used to record patient authorization for treatment or data use rather than to explore nuanced comfort levels across multiple data-sharing stakeholders. It overlaps with only one dimension of our template (consent) and doesn't appear to cover device usage, trust ranking, or adoption barriers. Presented as a static template, not an adaptive research instrument.

What it does well

  • Directly addresses patient consent, a core compliance need
  • Conversational/chat-style survey format from SurveySparrow may feel more approachable than a legal form
  • Likely simple to deploy for basic consent logging

Where it falls short

  • Consent capture only — no coverage of device usage history, multi-stakeholder trust comparisons, or adoption barriers
  • No adaptive AI or voice-based follow-up interview to explore reasoning behind consent choices
  • No automated quality scoring or auto-generated analysis report described

Ready to launch?

Open this template in the editor. Every part is yours to change before the first respondent sees it.

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