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すべてのテンプレート
Industry-Specific

Weight Loss Program Progress & Barriers Survey

Tracks how people in a weight loss program, coaching service, or health app are actually progressing — what's getting in their way, where they're putting effort, and which support features they'd value most — with an AI follow-up that reconstructs the last time they fell off track and what would have changed the outcome. Built for programs and coaches optimizing retention and results.

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設問の例

テンプレートの内容をプレビューできます。すべての設問は公開前に自由に編集できます。

全14問・約7分
Q01
メッセージ

Hi! Thanks for taking a few minutes to share how your weight loss journey has been going. Your responses are completely confidential and anonymized. Your honest answers help us improve the program — this should take about 6 minutes.

Q02
選択式必須

How long have you been using (Replace with your program/app name)? (Template note: swap in the actual program name before launching.)

  • Less than 1 month
  • 1-3 months
  • 3-6 months
  • 6-12 months
  • More than 1 year
Q03
オピニオンスケール必須

Compared to when you started, how satisfied are you with your progress toward your weight loss goal?

スケール: 1 – 7
最小:Not at all satisfied最大:Extremely satisfied
Q04
数値必須

In the last 30 days, on how many days did you follow your planned eating routine for most of the day?

Q05
マトリクス必須

How often has each of the following gotten in the way of your progress in the last month?

7行 × 5列
  • Lack of time for meal prep or exercise
  • Cravings or hunger between meals
  • Social situations (parties, eating out, family meals)
  • Cost of healthy food or program fees
  • Low motivation or mood
  • ほか2件
列: Never a problem · Rarely a problem · Sometimes a problem · Often a problem · Almost always a problem
Q06
ベスト・ワースト選択（MaxDiff）必須

Which of these types of support would help your progress most, and which would help least?

  • One-on-one coaching calls
  • Personalized meal plans
  • Exercise or workout plans
  • Progress tracking app or dashboard
  • Community or group support
  • Quick, easy recipe ideas
  • Reminders and accountability check-ins
各セットで最も良いもの・最も悪いものを選択最も良い:Would help me most最も悪い:Would help me least
Q07
ポイント配分

Thinking about a typical week, how do you split your effort across these areas? Distribute 100 points based on where you actually spend your time and energy.

  • Nutrition/diet
  • Exercise/physical activity
  • Sleep
  • Stress management
  • Tracking/logging progress
100ポイントを配分
Q08
評価スケール

How would you rate the support you've received from your coach, program, or app?

範囲: 1 – 5
最小:Poor最大:Excellent
Q09
オピニオンスケール必須

How likely are you to recommend this program to a friend or family member trying to lose weight?

スケール: 0 – 10
最小:Not at all likely最大:Extremely likely
Q10
AIインタビュー

Reconstruct the most recent time the respondent fell off track with their eating or exercise plan: what triggered it, what they actually did in the moment, and what happened afterward. Anchor on whichever obstacle they rated as happening 'often' or 'almost always' in the earlier question, and probe what kind of support would have changed the outcome. If they report high satisfaction with no real setbacks, ask what specifically is working and whether it would hold up during a busier or higher-stress stretch.

Q11
選択式必須

What's your primary goal right now?

  • Improve overall health
  • Increase energy and fitness
  • Manage a medical condition (e.g., diabetes, high blood pressure)
  • Prepare for a specific event
  • Feel more confident in my body
Q12
選択式

What is your age range?

  • Under 25
  • 25-34
  • 35-44
  • 45-54
  • 55-64
  • 65 or older
  • Prefer not to say
Q13
選択式

What is your gender identity?

  • Woman
  • Man
  • Non-binary/third gender
  • Prefer not to say
Q14
メッセージ

That's everything — thank you for sharing where things stand! Your answers feed directly into how we design coaching, meal support, and check-ins to help you (and others) stay on track.

含まれる機能

  • AIによる深掘り

    自由回答に合わせてAIが追加で質問し、固定のフォームでは拾えない具体的な内容を引き出します。

  • 注意確認設問

    急いだ回答や質の低い回答者を除外する仕組みを標準で備えています。

  • AIが作成する設問文

    文言、設問の順序、条件分岐をAIが調査の目的に合わせて作成します。

  • 自動レポート

    回答が集まると、テーマ、引用、わかりやすい要約が自動で作成されます。

他ツールとの比較

ほかのアンケートツールで最も近いテンプレートを調べました。それぞれの優れている点と、このテンプレートがさらに踏み込んでいる点をまとめています。

このテンプレートを選ぶ理由

  • Includes a dedicated AI follow-up interview that reconstructs the respondent's most recent time falling off track with eating or exercise, probing what specifically happened and what would have changed the outcome — something static forms can't do
  • Uses a matrix question to map how often specific barriers (time, motivation, cost, etc.) get in the way, plus a max-diff to rank which support features would help most vs least
  • Adds a constant-sum question to see how respondents actually split effort across areas in a typical week, alongside satisfaction, adherence, and recommend-likelihood scales for a full progress picture
  • Every response is automatically quality-scored and rolled into an auto-generated report, so coaches/programs get retention-ready insights without manually reading transcripts

Jotform

Weight Loss Program Participant Intake Form Template

This is an intake form for enrolling participants into a weight loss program, not a progress/barriers tracking survey. It's fielding-ready as a static form and benefits from Jotform's large template ecosystem and easy embedding, but it's built for onboarding, not ongoing retention or barrier analysis.

優れている点

  • Ready-to-use, customizable form fields for capturing participant intake details
  • Easy to embed or share and part of a broad template library
  • Likely has a free tier for basic use

物足りない点

  • Static intake form with no adaptive AI follow-up to probe why someone fell off track
  • No automated per-response quality scoring or auto-generated analytical reports
  • Focused on onboarding, not on tracking ongoing progress, barriers, or support preferences over time

Typeform

Medical Weight Loss Consultation Form Template

A consultation-style intake form for medical weight loss providers to gather patient info before or during a visit, not a recurring progress/barriers survey. It offers Typeform's polished conversational one-question-at-a-time interface, but it's a single fixed form rather than an adaptive interview tool.

優れている点

  • Clean, conversational one-question-at-a-time interface
  • Good fit for structured medical/clinical consultation intake
  • Easy to customize question wording and branding

物足りない点

  • No adaptive AI follow-up questioning — every respondent gets the same fixed question set
  • No automated quality scoring or auto-generated reports on responses
  • Built for a one-time consultation intake, not ongoing progress, barrier tracking, or retention analysis

よくあるご質問

「Weight Loss Program Progress & Barriers Survey」テンプレートにはどのような設問が含まれていますか？

すぐに使える設問が14問含まれており、最初の設問は次のとおりです：「Hi! Thanks for taking a few minutes to share how your weight loss journey has been going. Your responses are completely…」・「How long have you been using (Replace with your program/app name)? (Template note: swap in the actual program name befor…」・「Compared to when you started, how satisfied are you with your progress toward your weight loss goal?」。すべての設問は上でプレビューでき、自由に編集できます。

このアンケートの回答にはどのくらい時間がかかりますか？

回答者は通常、14問を約7分で回答し終えます。

テンプレートは編集できますか？

はい。公開前であれば、すべての設問、選択肢、順序を編集できます。設問の追加や削除のほか、調査の目的に合わせた作り直しをAIエディターに依頼することもできます。

このテンプレートは無料で使えますか？

はい。エディターで開けば、すぐに編集を始められます。お試しにアカウントは不要で、無料プランでアンケートを公開できます。

公開の準備はできましたか？

このテンプレートをエディターで開いてみてください。最初の回答者が目にする前に、すべてを自由に変更できます。

このテンプレートを使う無料で始める

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