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.
In the last 12 months, have you visited any health professional (e.g., doctor, nurse, therapist)?
- Yes
- No
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
How comfortable or uncomfortable are you with sharing your health information with medical providers?
How comfortable or uncomfortable are you with sharing your health data with fitness or wearable apps (e.g., Fitbit, Apple Health)?
Please rank the following types of health data from most comfortable to least comfortable to share.
- Basic profile (age, sex)
- Step counts/activity minutes
- Heart rate or sleep data
- Medication list
- Lab results
- Mental health notes or assessments
- Genetic/ancestry data
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?
What is your age?
- 18–24
- 25–34
- 35–44
- 45–54
- 55–64
- 65+
- Prefer not to say
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.
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
- Online portal
- Synced data from a wearable or app
- Other (please specify)
- I don't recall
How comfortable or uncomfortable are you with sharing your health data with patient portals (e.g., MyChart)?
How important or unimportant is it to you to control who can access your health data?
Which best describes your gender?
- Man
- Woman
- Non-binary
- Prefer to self-describe
- Prefer not to say
How comfortable or uncomfortable are you with sharing your health information with your health insurer?
How comfortable or uncomfortable are you with sharing your health data with telemedicine or virtual care platforms?
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)
Do you currently have health insurance coverage?
- Yes
- No
- Prefer not to say
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
In which region do you currently live?
- Africa
- Asia
- Europe
- North America
- South America
- Oceania
- Prefer not to say
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
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.
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
- Uses a series of opinion-scale questions to quantify comfort sharing health data across distinct contexts (primary care providers, fitness/wellness apps, patient portals, telehealth), not just a single generic comfort rating.
- Includes a ranking question asking respondents to order health data types from most to least comfortable to share, surfacing relative sensitivity rather than isolated yes/no consent.
- Adds an AI follow-up interview at the end that adaptively probes respondents' own stated concerns and preferences, generating qualitative depth a static form cannot capture.
- Captures demographic and coverage variables (age, gender, insurance status, region, education, employment) so compliance and privacy teams can segment trust attitudes by population.
SurveySparrow
Patient Consent Form TemplateThis is a functional patient consent form for authorizing treatment or data use, not a survey designed to measure attitudes toward health data sharing. It's fielding-ready as a form, but it collects signatures/agreement rather than exploring comfort levels, concerns, or trade-offs. Relevant only as an adjacent healthcare-data document, not a comparable attitudes/preferences instrument.
What it does well
- Ready-to-use, healthcare-specific consent template within a broader form/survey builder
- Likely supports standard customization and mobile-friendly completion
- Part of a larger library of healthcare templates, easing adoption for clinics
Where it falls short
- Captures binary consent/agreement rather than graded comfort levels, ranked preferences, or reasons behind privacy concerns
- No adaptive AI follow-up to explore why a patient is or isn't comfortable sharing specific data types
- No per-response quality scoring or transparent prompt methodology for the questions asked
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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