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Research Study Eligibility Screening & Consent Quiz Template

Pre-screen participants and verify informed consent with this ready-to-use survey template. Filter recruits, meet IRB standards, and boost data quality.

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Sample Survey Items

Q1
chat message
Welcome: This brief screening will check eligibility and your understanding of the study. It takes about 5–10 minutes. Participation is voluntary.
Q2
multiple choice
Are you 18 years of age or older?
  • Yes, I am 18 or older
  • No, I am under 18
Q3
chat message
About this study: You will answer short questions about attitudes and experiences. Expected time is about 5–10 minutes. Participation is voluntary.
Q4
chat message
Risks: Minimal risk, such as mild discomfort from certain questions. You may skip any question you prefer not to answer. You can stop at any time without penalty.
Q5
chat message
Privacy: Responses are collected without direct identifiers, stored securely, and analyzed in aggregate. For questions, contact the research team listed in the study posting.
Q6
multiple choice
Which statement best describes your rights if you join this study?
  • Participation is voluntary, and you may withdraw at any time without penalty.
  • You must answer all questions to receive any compensation.
  • Your identifiable data will be made public.
  • There are absolutely no risks of discomfort.
Q7
multiple choice
Do you consent to participate in this study under the terms described?
  • Yes, I agree to participate.
  • No, I do not agree to participate.
Q8
dropdown
What is your age group?
Q9
multiple choice
What is your gender?
  • Woman
  • Man
  • Non-binary
  • Prefer not to say
Q10
dropdown
What is the highest level of education you have completed?
Q11
multiple choice
What is your current employment status?
  • Employed full-time
  • Employed part-time
  • Student
  • Unemployed
  • Retired
  • Prefer not to say
Q12
dropdown
Where do you currently live?
Q13
multiple choice
In the last 12 months, have you participated in any academic studies?
  • Yes
  • No
  • Not sure
Q14
multiple choice
Attention check: To confirm you are paying attention, please select “Prefer not to say.”
  • Yes
  • No
  • Prefer not to say
  • Not sure
Q15
long text
Any questions or concerns about the study information?
Max 600 chars
Q16
ai interview
AI Interview: 2 Follow-up Questions on your responses to this screening
AI Interview
Q17
chat message
Thank you. If you were not eligible or chose not to participate, no further action is needed. Otherwise, you may proceed to the main study.

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Research Study Eligibility Screening & Consent Quiz Template - Survey Template | QuestionPunk