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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샘플 질문

템플릿에 포함된 내용을 미리 확인해 보세요. 모든 질문은 설문 공개 전에 자유롭게 수정할 수 있습니다.

질문 14개 · 약 7분

Q01

메시지

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

객관식필수

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

의견 척도필수

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

척도: 1 – 7

최소:Not at all satisfied최대:Extremely satisfied

Q04

숫자필수

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

Q05

매트릭스필수

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

7개 행 × 5개 열

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
외 2개

열: Never a problem · Rarely a problem · Sometimes a problem · Often a problem · Almost always a problem

Q06

최선·최악 선택형(MaxDiff)필수

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

세트별 최선·최악 선택최선:Would help me most최악:Would help me least

Q07

점수 배분

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

100점 배분

Q08

평점 척도

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

범위: 1 – 5

최소:Poor최대:Excellent

Q09

의견 척도필수

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

척도: 0 – 10

최소:Not at all likely최대:Extremely likely

Q10

AI 인터뷰

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

객관식필수

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

객관식

What is your age range?

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

Q13

객관식

What is your gender identity?

Woman
Man
Non-binary/third gender
Prefer not to say

Q14

메시지

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.

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

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.

잘하는 점

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

아쉬운 점

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.

잘하는 점

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

아쉬운 점

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

설문을 공개할 준비가 되셨나요?

이 템플릿을 편집기에서 열어 보세요. 첫 응답자가 보기 전에 모든 부분을 원하는 대로 바꿀 수 있습니다.

Use this template 무료로 시작하기

샘플 질문

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.

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

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

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

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

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

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.

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

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

What's your primary goal right now?

What is your age range?

What is your gender identity?

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.

포함된 기능

AI 후속 질문

주의력 확인 장치

AI가 작성한 문안

자동 리포트

다른 서비스와 비교

이 템플릿을 선택하는 이유

잘하는 점

아쉬운 점

잘하는 점

아쉬운 점

설문을 공개할 준비가 되셨나요?