Q01
Message
All templates
Diet and Exercise Habits & Motivation Survey
Captures real-world eating and activity patterns, what's blocking consistency, and what actually keeps people motivated — for wellness programs, coaches, and fitness apps designing support that matches how people actually live. An AI follow-up interview digs into the specific barrier behind someone's confidence score instead of settling for a generic checkbox.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
13 questions · ~7 min
Q02
Multiple ChoiceRequired
In the last 7 days, on how many days did you do at least 7 minutes of physical activity (including brisk walking)?
- 0 days
- 1-2 days
- 3-4 days
- 5-6 days
- Every day
Q03
Multiple Choice
Which types of exercise have you done in the last 30 days?
- Cardio (running, cycling, swimming)
- Strength or resistance training
- Yoga, Pilates, or flexibility work
- Team or recreational sports
- Walking as exercise
Q04
MatrixRequired
How often do the following apply to your typical week?
5 rows × 5 columns
- I eat vegetables or fruit with most meals
- I plan or prep meals in advance
- I limit sugary drinks and processed snacks
- I eat without distractions like a screen
- I get enough sleep to support my activity level
Columns: Never · Rarely · Sometimes · Often · Always
Q05
Opinion ScaleRequired
How confident are you that you can stick to healthy eating and exercise habits over the next 3 months?
Scale: 1 – 10
Min:Not at all confidentMax:Extremely confident
Q06
Best–Worst Trade-off (MaxDiff)
For each set, pick what would help you stick to a diet and exercise routine most, and what would help least.
- More free time in my schedule
- More energy or less fatigue
- Simple, ready-made meal plans
- A workout buddy or community support
- Clear tracking of my progress
- Affordable access to healthy food
- Professional coaching or guidance
Pick best & worst per setBest:Would help mostWorst:Would help least
Q07
Point Allocation
Thinking about what gets in the way, distribute 100 points across these barriers based on how much each one holds you back.
- Lack of time
- Cost of healthy food or gym access
- Lack of motivation
- Injury or health limitations
- Lack of knowledge on what to do
- Lack of support from others
Allocate 100 points
Q08
Rating ScaleRequired
How satisfied are you with your current fitness level?
Range: 1 – 5
Min:Very dissatisfiedMax:Very satisfied
Q09
AI Interview
Explore the reasoning behind the respondent's confidence score for sticking to healthy habits over the next 3 months. If confidence was low or middling, identify the single biggest real-world barrier (time, cost, motivation, knowledge, support, or health limitation) and get a concrete recent example of it happening. If confidence was high, probe what specific system or habit is making it work so it can be reused with others.
Q10
Message
That wraps up the survey portion — just two quick optional questions left about you.
Q11
Multiple Choice
Which age range do you fall into?
- Under 18
- 18-24
- 25-34
- 35-44
- 45-54
- 55-64
- 65+
- Prefer not to say
Q12
Multiple Choice
What is your gender?
- Woman
- Man
- Non-binary
- Prefer to self-describe
- Prefer not to say
Q13
Message
Thank you for sharing this! Your responses will be used to shape more realistic diet and exercise support — no generic plans, just habits and barriers that match real life.
What’s included
AI follow-ups
Adaptive probes on open-ended answers that pull out detail a static form would miss.
Attention checks
Built-in safeguards against rushed answers and low-quality respondents.
AI-drafted copy
Wording, ordering, and branching written by the AI — tuned to your research goal.
Auto report
Themes, quotes, and a plain-English summary write themselves once responses come in.
How it compares
We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.
Why this template
- Goes beyond a checkbox confidence score with an AI follow-up interview that digs into the specific barrier behind someone's rating, in the respondent's own words
- Uses a constant-sum question to force respondents to weigh and distribute barriers rather than just picking one, giving more nuanced prioritization data
- Pairs a max-diff exercise (what would actually help someone stick to a routine) with a weekly-frequency matrix to capture both stated motivators and real behavioral patterns
- Frames the whole survey conversationally with chat-style intro/closing messages, making it feel like a guided conversation rather than a cold form
Jotform
Diet and exercise Form TemplateThis is a static, drag-and-drop form template rather than a survey instrument designed for behavioral research — it's built for quick data capture (e.g., logging habits) and easy customization. It's fielding-ready but light on structured question design like matrix or ranking logic. Good for simple intake, less suited to uncovering motivational nuance.
What it does well
- Highly customizable form builder
- Fast to deploy and embed
- Simple, familiar Jotform ecosystem integrations
Where it falls short
- No adaptive follow-up questioning — respondents get the same static fields regardless of answers
- No mechanism to explore the 'why' behind a rating or barrier
- No published methodology or scoring transparency
SurveyMonkey
Exercise, Fitness, And Diet Survey TemplateA standard fielding-ready survey template from an established survey platform, likely covering frequency and satisfaction questions similar in spirit to ours. It benefits from SurveyMonkey's broad distribution and analytics tools, but the question set is fixed once launched. No indication of AI-driven probing into individual responses.
What it does well
- Established survey distribution and panel options
- Built-in analytics and reporting dashboard
- Familiar, trusted platform for respondents
Where it falls short
- Static question flow with no adaptive AI interviewing to probe motivation or barriers
- No voice-based interview option
- No per-response quality scoring
SurveySparrow
Diet and Exercise Survey TemplateSurveySparrow's conversational, chat-style survey format makes this template feel more engaging than a plain form, and it's ready to field as-is. However, the conversational feel is a UI layer over pre-scripted questions, not true adaptive follow-up based on response content.
What it does well
- Conversational, chat-like question presentation
- Mobile-friendly, engaging UI
- Ready-to-use healthcare template category
Where it falls short
- No AI-generated follow-up questions tailored to individual answers
- No voice interview or screen-share task capability
- No transparent prompt or scoring methodology published
Typeform
Health and Diet Survey TemplateTypeform's one-question-at-a-time format is visually polished and fielding-ready, well-suited for casual respondent engagement. Logic branching can route respondents based on prior answers, but this is rule-based branching, not open-ended AI probing of the reasoning behind a score.
What it does well
- Clean, engaging one-question-per-screen design
- Conditional logic branching between questions
- Strong brand reputation for respondent-friendly surveys
Where it falls short
- Branching logic is rule-based, not adaptive AI conversation that digs into open-ended reasoning
- No voice AI interview mode
- No automated per-response quality scoring or auto-generated qualitative reports
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.