About this template
This academic research template is designed for public health professionals and researchers conducting sensitive health-related studies. It provides a structured, professional framework for gathering essential data on demographics, lifestyle behaviors, and medical history, ensuring that researchers can focus on their analysis rather than form design.
The template includes pre-built sections for tracking sexual health behaviors, testing frequency, and socioeconomic factors. By using this standardized format, you can maintain consistency across your research participants, simplify data aggregation, and ensure that all necessary variables are captured in a clear, logical flow.
Key features
- Comprehensive sections for demographic and behavioral data
- Standardized health history and testing frequency questions
- Clear, respectful language for sensitive topics
- Easy to export results to Sheets for statistical analysis
- Fully customizable to fit specific study parameters
Use cases
- Public health studies on disease prevalence
- Academic research on social determinants of health
- Community health outreach and assessment programs
- University-led clinical or behavioral research
What this form collects
- Gender (Multiple choice)Please select your gender identity.
- Age Range (Dropdown)Select your current age group.
- Annual Income Range (Dropdown)Please indicate your approximate annual household income.
- Medical History (Multiple choice)Do you have any pre-existing medical conditions?
- Please list any relevant medical conditions (Paragraph)If you answered yes above, please specify the condition(s).
- Sexual Partners (Short answer)Approximately how many sexual partners have you had in the last 60 days?
- Condom Use Frequency (Main Partner) (Multiple choice)How often do you use condoms with your main partner?
- HIV/STD Testing Frequency (Linear scale)On a scale of 1 to 5, how frequently do you get tested for STIs? (1 = Never, 5 = Regularly/Quarterly)
- Reasons for Not Testing (Paragraph)If you do not test regularly, what are the primary reasons? (e.g., cost, access, stigma)
FAQ
Is this template suitable for sensitive health research?
Yes, the template is structured to handle sensitive health questions professionally. We recommend ensuring your study protocol meets your institutional review board (IRB) requirements.
Can I add my own research questions?
Absolutely. You can add, remove, or modify any questions in this template to align perfectly with your specific research methodology.
How do I analyze the data collected?
Google Forms automatically sends all responses to a Google Sheet, where you can easily perform statistical analysis, create charts, or export the data for use in SPSS, R, or Python.
Can I keep responses anonymous?
Yes, you can configure your form settings to not collect email addresses, allowing for fully anonymous data collection.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.