Q01
Long Text
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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 · ~4 min
Q02
Multiple Choice
In the last 6 months, have you used any remote health monitoring device (e.g., blood pressure cuff, glucose monitor, smartwatch)?
Q03
Long Text
Overall, how comfortable are you with using remote health monitoring devices?
Q04
Long Text
How comfortable are you sharing remote monitoring data with your personal healthcare provider?
Q05
Multiple Choice
Which of the following would help you use remote monitoring more comfortably? Select all that apply.
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
Long Text
What is your age group?
Q08
Long Text
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.
Q10
Long Text
To what extent do you agree or disagree: Using remote monitoring would help me manage my health.
Q11
Long Text
How comfortable are you sharing remote monitoring data with a hospital or health system?
Q12
Multiple Choice
How do you describe your gender?
Q13
Long Text
Thinking about the device you used most often, how frequently did you use it in the last 30 days?
Q14
Long Text
How willing are you to use a remote monitoring device in the next 3 months?
Q15
Long Text
How comfortable are you sharing remote monitoring data with your health insurer?
Q16
Long Text
What is the highest level of education you have completed?
Q17
Multiple Choice
In the last 6 months, did you share data from any of these devices with a healthcare provider?
Q18
Long Text
How comfortable are you sharing remote monitoring data with the device manufacturer or a technology company?
Q19
Multiple Choice
What is your current employment status?
Q20
Long Text
What, if anything, kept you from sharing your device data with a healthcare provider?
Q21
Long Text
How important is it to you to control which health data are shared and with whom?
Q22
Long Text
Where do you live most of the year?
Q23
Multiple Choice
Which of the following concerns, if any, do you have about sharing remote monitoring data? Select all that apply.
Q24
Multiple Choice
How many times have you seen a healthcare professional in the last 12 months?
Q25
Long Text
Please rank the following from most trusted to least trusted to handle your health device data.
Q26
Multiple Choice
Do you have a smartphone you use at least weekly?
Q27
Multiple Choice
Which consent approach would you prefer for sharing your device data?
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.
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Open this template in the editor. Every part is yours to change before the first respondent sees it.