Q01
메시지
모든 템플릿
Personal Health & Wellness Check-In Survey
A periodic self-assessment covering physical health, sleep, stress, activity levels, and emerging symptoms — used by clinics, employers, or wellness programs to spot concerns early. An AI follow-up interview digs into whatever symptom or concern the respondent flagged as most pressing, capturing duration, severity, and impact that a checkbox can't.
샘플 질문
템플릿에 포함된 내용을 미리 확인해 보세요. 모든 질문은 설문 공개 전에 자유롭게 수정할 수 있습니다.
질문 13개 · 약 7분
Q02
의견 척도필수
Overall, how would you rate your physical health right now?
척도: 0 – 10
최소:Poor최대:Excellent
Q03
슬라이더 매트릭스필수
Thinking about the past 2 weeks, how would you rate each of the following?
4개 행, 각 행마다 슬라이더 1개
- Energy level
- Stress level
- Sleep quality
- Overall mood
슬라이더 0–10최소:Very low / poor최대:Very high / great
Q04
객관식필수
In the last 30 days, on how many days did you get at least 7 minutes of physical activity?
- 0 days
- 1–4 days
- 5–9 days
- 10–19 days
- 20+ days
Q05
숫자필수
On an average night over the past week, about how many hours did you sleep?
Q06
객관식필수
Which of the following have you noticed in the past 2 weeks?
- Persistent fatigue
- Trouble falling or staying asleep
- Headaches
- Digestive issues
- Muscle or joint pain
- Anxiety, worry, or low mood
- Shortness of breath or chest discomfort
Q07
객관식필수
When did you last have a general check-up or physical exam with a doctor?
- Within the last year
- 1–2 years ago
- More than 2 years ago
- Never
- Not sure
Q08
평점 척도필수
How confident do you feel in your ability to manage your current health needs day-to-day?
범위: 1 – 5
최소:Not confident at all최대:Very confident
Q09
AI 인터뷰
If the respondent flagged any symptom in the checklist question (fatigue, sleep trouble, headaches, digestive issues, pain, anxiety/mood, or breathing issues), probe that specific one first: how long it's been going on, how severe it feels day to day, whether it's getting better, worse, or staying the same, and whether it's affected work, sleep, or relationships. If they selected 'None of these', instead explore what's been going well and whether anything is building up that they haven't mentioned yet. If they haven't seen a doctor in over a year, gently ask what's kept them from scheduling one.
Q10
장문형
Is there anything else about your health or wellbeing you'd like to share?
Q11
객관식
Which age range do you fall into?
- Under 18
- 18–29
- 30–44
- 45–59
- 60–74
- 75+
- Prefer not to say
Q12
객관식
What is your gender?
- Female
- Male
- Non-binary
- Self-describe
- Prefer not to say
Q13
메시지
Thank you for checking in! Your answers help identify patterns early and shape the support and resources offered to you. If you flagged anything urgent, please don't wait — reach out to a healthcare provider directly.
포함된 기능
AI 후속 질문
정형화된 설문이 놓치는 세부 내용을, 주관식 답변에 맞춰 AI가 심층 질문으로 끌어냅니다.
주의력 확인 장치
성의 없는 답변과 저품질 응답자를 걸러내는 내장 안전장치입니다.
AI가 작성한 문안
문구, 질문 순서, 분기 로직까지 AI가 연구 목표에 맞춰 작성합니다.
자동 리포트
응답이 모이면 주요 주제, 인용문, 이해하기 쉬운 요약이 자동으로 작성됩니다.
다른 서비스와 비교
다른 설문 도구의 가장 유사한 템플릿을 검토했습니다. 그 도구들이 잘하는 점과, 이 템플릿이 한발 더 나아가는 지점을 정리했습니다.
이 템플릿을 선택하는 이유
- Opens with a friendly chat message and closes with a thank-you message, framing the check-in as a conversation rather than a cold form
- Covers physical health self-rating, a 2-week slider matrix across multiple wellness dimensions, activity days, sleep hours, a symptom checklist, and last-check-up timing in one structured flow
- An AI follow-up interview automatically digs into whichever symptom or concern the respondent flags as most pressing, capturing duration, severity, and impact that a checkbox alone can't surface
- Adds an open-ended long-text question, demographic breakdowns, and auto-generated reports so clinics, employers, or wellness programs can spot patterns and act early
Typeform
Student Mental Health Checkin Survey TemplateThis is a ready-to-field template built around Typeform's conversational, one-question-at-a-time interface, focused specifically on student mental health check-ins. It's a narrower periodic check-in than QuestionPunk's template, covering mental health only rather than physical health, sleep, activity, and stress together, and it targets students rather than a general clinic/employer/wellness-program population.
잘하는 점
- Typeform's polished, mobile-friendly conversational UI is well suited to sensitive check-in topics
- Purpose-built for a specific audience (students) and single domain (mental health), which can feel more tailored for that niche
아쉬운 점
- Static question set with no adaptive AI follow-up to probe deeper into a flagged concern's duration, severity, or impact
- No published methodology or transparent prompt logic since there are no AI-driven questions to document
- Scope limited to mental health and students, missing physical health, sleep, activity levels, and general check-up tracking
QuestionPro
Contactless health check survey templateThis template appears designed for entry-point/contactless symptom screening (e.g., before entering a workplace or facility) rather than an ongoing personal wellness self-assessment. It's a fielding-ready form, but its purpose is narrower and more transactional than a periodic physical, sleep, stress, and activity check-in.
잘하는 점
- Backed by QuestionPro's enterprise survey platform with standard logic and distribution features
- Suited to quick, repeatable screening use cases like facility or workplace entry checks
아쉬운 점
- Static checklist format with no adaptive AI interview to explore whatever symptom a respondent flags in more depth
- No automated per-response quality scoring or transparent AI prompt documentation, since it isn't AI-interview based
- Narrower scope (contactless symptom screening) versus a broader periodic wellness check covering sleep, stress, and activity trends
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이 템플릿을 편집기에서 열어 보세요. 첫 응답자가 보기 전에 모든 부분을 원하는 대로 바꿀 수 있습니다.