Q01
Long Text
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Health Data Sharing Trust & Privacy Preferences Survey
Measures patient comfort, consent preferences, and privacy concerns when sharing health data across providers, insurers, and digital health tools. Ideal for healthcare organizations, privacy teams, and compliance officers seeking to understand patient attitudes toward data sharing.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
21 questions · ~4 min
Q02
Multiple Choice
In the last 12 months, have you visited any health professional (e.g., doctor, nurse, therapist)?
Q03
Multiple Choice
In the last 12 months, which of the following health or wellness tools have you used? Select all that apply.
Q04
Long Text
How comfortable or uncomfortable are you with sharing your health information with medical providers?
Q05
Long Text
How comfortable or uncomfortable are you with sharing your health data with fitness or wearable apps (e.g., Fitbit, Apple Health)?
Q06
Long Text
Please rank the following types of health data from most comfortable to least comfortable to share.
Q07
AI Interview
Based on your responses throughout this survey, please share any additional thoughts or feelings about how your health data is shared. What concerns, if any, stand out most to you?
Q08
Long Text
What is your age?
Q09
Long Text
Thank you for completing this survey! Your responses have been recorded and will be used in aggregate to improve health data sharing practices. If you have any questions about this research, please contact the research team.
Q10
Multiple Choice
During your most recent visit to a health professional, how did you share information with your provider? Select all that apply.
Q11
Long Text
How comfortable or uncomfortable are you with sharing your health data with patient portals (e.g., MyChart)?
Q12
Long Text
How important or unimportant is it to you to control who can access your health data?
Q13
Multiple Choice
Which best describes your gender?
Q14
Long Text
How comfortable or uncomfortable are you with sharing your health information with your health insurer?
Q15
Long Text
How comfortable or uncomfortable are you with sharing your health data with telemedicine or virtual care platforms?
Q16
Multiple Choice
Which of the following would most increase your willingness to share health data with a new app or service? Select up to two.
Q17
Multiple Choice
Do you currently have health insurance coverage?
Q18
Multiple Choice
In the last 12 months, have you shared any health data directly with your health insurer?
Q19
Long Text
In which region do you currently live?
Q20
Long Text
What is the highest level of education you have completed?
Q21
Multiple Choice
What is your current employment status?
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.
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.