Template

Health questionnaire

A self-assessment of wellbeing: sleep, stress, habits. Built as a questionnaire for a clinic or a corporate health programme.

  • 13 blocks
Showcase

What the template is made of

Every block in the order it sits in the builder. Branching decides which of them a given person actually sees.

  1. Self-assessment Text block
  2. Consent to anonymous participation Consent
  3. About you Section break
  4. Your gender Single choice
  5. Date of birth Date
  6. How you feel Section break
  7. Over the past month, how often did you… Matrix
  8. Sleep quality over the past week Slider
  9. Stress level Slider
  10. Habits Section break
  11. Which of these habits do you have? Multiple choice
  12. Do you take medication regularly? Yes / No
  13. What would you like to change about your lifestyle? Long answer
Template

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