All templates

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 · ~10 min
Q01
Message

Welcome to this research survey on health data sharing preferences. This survey takes approximately 5–7 minutes to complete. Your participation is entirely voluntary, and you may stop at any time. There are no right or wrong answers — we are simply interested in your honest opinions. All responses are confidential, will be anonymized, and reported only in aggregate for internal research purposes. By continuing, you acknowledge that you have read and understood this information.

Q02
Multiple Choice

In the last 12 months, have you visited any health professional (e.g., doctor, nurse, therapist)?

  • Yes
  • No
Q03
Multiple Choice

In the last 12 months, which of the following health or wellness tools have you used? Select all that apply.

  • Fitness/activity tracker (e.g., Fitbit, Apple Watch)
  • Nutrition or calorie app
  • Symptom checker or health chatbot
  • Medication reminder app
  • Telemedicine/virtual care platform
  • Patient portal (e.g., MyChart)
  • Sleep tracking app/device
  • Mental health app
  • Other (please specify)
  • None of the above
Q04
Opinion Scale

How comfortable or uncomfortable are you with sharing your health information with medical providers?

Scale: 17
Min:Very uncomfortableMax:Very comfortable
Q05
Opinion Scale

How comfortable or uncomfortable are you with sharing your health data with fitness or wearable apps (e.g., Fitbit, Apple Health)?

Scale: 17
Min:Very uncomfortableMax:Very comfortable
Q06
Ranking

Please rank the following types of health data from most comfortable to least comfortable to share.

  1. Basic profile (age, sex)
  2. Step counts/activity minutes
  3. Heart rate or sleep data
  4. Medication list
  5. Lab results
  6. Mental health notes or assessments
  7. Genetic/ancestry data
Drag to rank
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
Dropdown

What is your age?

  • 18–24
  • 25–34
  • 35–44
  • 45–54
  • 55–64
  • 65+
  • Prefer not to say
Q09
Message

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.

  • Spoke in person
  • Filled out paper forms
  • Phone call
  • Email
  • Online portal
  • Synced data from a wearable or app
  • Other (please specify)
  • I don't recall
Q11
Opinion Scale

How comfortable or uncomfortable are you with sharing your health data with patient portals (e.g., MyChart)?

Scale: 17
Min:Very uncomfortableMax:Very comfortable
Q12
Opinion Scale

How important or unimportant is it to you to control who can access your health data?

Scale: 17
Min:Very unimportantMax:Very important
Q13
Multiple Choice

Which best describes your gender?

  • Man
  • Woman
  • Non-binary
  • Prefer to self-describe
  • Prefer not to say
Q14
Opinion Scale

How comfortable or uncomfortable are you with sharing your health information with your health insurer?

Scale: 17
Min:Very uncomfortableMax:Very comfortable
Q15
Opinion Scale

How comfortable or uncomfortable are you with sharing your health data with telemedicine or virtual care platforms?

Scale: 17
Min:Very uncomfortableMax:Very comfortable
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.

  • Clear explanation of how my data will be used
  • Ability to delete my data at any time
  • Knowing data is stored in my country
  • Endorsement by my doctor or health system
  • Independent security certification
  • Option to share anonymized data only
  • Other (please specify)
Q17
Multiple Choice

Do you currently have health insurance coverage?

  • Yes
  • No
  • Prefer not to say
Q18
Multiple Choice

In the last 12 months, have you shared any health data directly with your health insurer?

  • Yes — through claims only
  • Yes — via a wellness program
  • Yes — by connecting an app or device
  • Not sure
  • No
Q19
Dropdown

In which region do you currently live?

  • Africa
  • Asia
  • Europe
  • North America
  • South America
  • Oceania
  • Prefer not to say
Q20
Dropdown

What is the highest level of education you have completed?

  • Less than high school
  • High school or equivalent
  • Some college/Associate
  • Bachelor's degree
  • Graduate or professional degree
  • Trade/Vocational
  • Prefer not to say
Q21
Multiple Choice

What is your current employment status?

  • Employed full time
  • Employed part time
  • Self-employed
  • Student
  • Homemaker
  • Unemployed
  • Retired
  • Prefer not to say

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.