Medical Web Use example 
This is an example Medical Web Use survey. This survey includes questions like:
Does your office provide a website for patients? 
Which of the following does your website provide for patients? (Check all that apply) 
Do you recommend medical websites to your patients?  
We hope this will help you create your own Medical Web Use  survey. We
have not tested the validitiy or reliability of this survey. However, you may
use this as a starting point to help your own survey instrument. Feel free to 
change and edit any of our survey templates to help you get started. 
1)  Does your office provide a website for patients?
  Select one... 
  Yes 
  No (go to question 3) 
 
2)  Which of the following does your website provide for patients? (Check all that apply)
3)  Do you recommend medical websites to your patients?
  Select one... 
  Yes 
  No (go to question 5) 
 
4)  Please list below the medical websites you have recommended to your 
patients.  Include web addresses (URLs) if possible.
5)  Do you recommend specific medical discussion forums to your 
patients?
  Select one... 
  No 
  Yes 
 
6)  Do you use the Internet to access medical care or treatment information?
  Select one... 
  Yes 
  No (go to question 8) 
 
7)  What websites do you access for medical care or treatment information?
8)  Do you use web-based case studies for continuing education credits?
  Select one... 
  No 
  Yes 
 
9)  How often do patients discuss with you medical information they have obtained from the Internet?
10)  In what ways has medical information your patients received from the Internet been helpful in treating your patients? (Check all that apply)
11)  In what ways has medical information your patients received over the Internet been harmful or impeded patient care? (Check all that apply)
12)  Please tell us of any medical websites that you feel are particularly harmful for patients to obtain information from.
13)  Are you male or female?
  Select one... 
  Male 
  Female 
 
14)  What is your age?
  Select one... 
  20-25 
  26-30 
  31-35 
  36-40 
  41-45 
  46-50 
  51-55 
  56-60 
  61-65 
  Over 65 
 
15)  How long have you been in practice?
  Select one... 
  Less than 1 year 
  1-3 years 
  4-6 years 
  7-9 years 
  10-12 years 
  13-15 years 
  16-18 years 
  19-20 years 
  More than 20 years 
 
16)  Do you work in private practice, clinic or medical group, or in a hospital?