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Finance & Insurance

Consumer Financial Confidence, Savings & Debt Stress Survey

Measures household financial confidence, savings buffer adequacy, debt stress, and behavioral coping strategies. Designed for consumer research panels to track financial resilience and segment by financial health.

Sample questions

A preview of what’s in the template. Every question is editable before you launch.

23 questions · ~10 min
Q01
Message

Welcome, and thank you for participating in this survey about household finances. This survey asks about your financial outlook, savings, debt, and recent financial decisions. It should take approximately 11 minutes to complete. Your participation is entirely voluntary, and you may stop at any time. There are no right or wrong answers — we are interested in your honest opinions and experiences. All responses are confidential and will be reported only in aggregate. Please click 'Next' to begin.

Q02
Opinion Scale

How confident are you in your household's financial situation over the next 12 months?

Scale: 17
Min:Not at all confidentMax:Very confident
Q03
Multiple Choice

Do you currently have any liquid savings you could access within 7 days?

  • Yes
  • No
Q04
Multiple Choice

Do you currently carry any debt (e.g., credit cards, loans, BNPL)?

  • Yes
  • No
Q05
Multiple Choice

Which of the following actions, if any, have you taken to manage your cash flow in the last 30 days? Select all that apply.

  • Delayed a planned purchase
  • Used savings to cover expenses
  • Carried a balance on a credit card
  • Borrowed from friends or family
  • Used Buy Now, Pay Later (BNPL)
  • Postponed a bill payment
  • None of the above
Q06
Long Text

Based on your responses in this survey, is there anything else you'd like to share about your current financial situation or the decisions you're making?

Q07
Multiple Choice

What is your age?

  • 18–24
  • 25–34
  • 35–44
  • 45–54
  • 55–64
  • 65 or older
  • Prefer not to say
Q08
Message

Thank you for completing this survey. Your responses have been recorded and will be treated confidentially. We appreciate your time.

Q09
Multiple Choice

Over the next 6 months, do you expect your total household income to:

  • Increase
  • Stay about the same
  • Decrease
  • Not sure
Q10
Dropdown

Approximately how many months of essential expenses could your current savings cover?

  • 0 — no savings buffer
  • Less than 1 month
  • 1–2 months
  • 3–5 months
  • 6–11 months
  • 12 months or more
  • Not sure
Q11
Multiple Choice

Which types of debt do you currently have? Select all that apply.

  • Credit card balance
  • Auto loan/lease
  • Student loan
  • Mortgage/home loan
  • Personal loan
  • Buy Now, Pay Later (BNPL)
  • Overdraft
  • Other
Q12
Ranking

If you received an extra 100 units of your local currency this month, how would you prioritize spending it? Please rank from highest to lowest priority.

  1. Short-term savings / emergency fund
  2. Debt repayment
  3. Essential expenses
  4. Discretionary spending
  5. Investing / long-term goals
Drag to rank
Q13
AI Interview

We'd like to understand your financial decisions in a bit more depth. An AI moderator will ask you a couple of brief follow-up questions based on your earlier responses.

Q14
Multiple Choice

What is your gender?

  • Man
  • Woman
  • Non-binary
  • Prefer not to say
Q15
Multiple Choice

Compared with 12 months ago, would you say your financial cushion (savings relative to expenses) is:

  • Stronger
  • About the same
  • Weaker
  • Not sure
Q16
Multiple Choice

In the last 3 months, how often did you add money to savings?

  • Weekly
  • Monthly
  • Less than monthly
  • Not at all
Q17
Opinion Scale

In the last 30 days, how stressed have you felt about your debt obligations?

Scale: 17
Min:Not at all stressedMax:Extremely stressed
Q18
Dropdown

Where do you currently live?

  • United States
  • United Kingdom
  • Canada
  • Australia
  • Europe
  • India
  • Other
Q19
Opinion Scale

How confident are you that you will reach your savings goals this year?

Scale: 17
Min:Not at all confidentMax:Very confident
Q20
Opinion Scale

How difficult is it for you to make your required minimum payments this month?

Scale: 17
Min:Not at all difficultMax:Extremely difficult
Q21
Multiple Choice

What is the highest level of education you have completed?

  • Some high school or less
  • High school diploma or equivalent
  • Some college / associate degree
  • Bachelor's degree
  • Postgraduate degree
  • Prefer not to say
Q22
Multiple Choice

Have you missed or been late on any bill or loan payment in the last 90 days?

  • Yes
  • No
  • Prefer not to say
Q23
Multiple Choice

What is your current employment status?

  • Employed full-time
  • Employed part-time
  • Self-employed
  • Unemployed and looking
  • Unemployed and not looking
  • Student
  • Retired
  • Prefer not to say

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

  • Combines quantitative confidence, savings-buffer, and debt-stress scales with a dedicated AI follow-up interview that probes the reasoning behind each household's financial decisions in more depth
  • Includes a ranking exercise on how respondents would allocate a hypothetical windfall, giving behavioral insight beyond simple multiple-choice questions
  • Captures coping behaviors (missed payments, cash-flow actions) alongside financial health metrics, enabling segmentation by financial resilience and demographics
  • Backed by transparent, inspectable prompts and automated report generation, available on a free tier or the $50/mo Business plan

Jotform

Four-Minute Financial Health Check Form Template

A short, fielding-ready static form aimed at quickly gauging a respondent's financial health rather than deep behavioral segmentation. It's built for speed and simplicity rather than depth of insight into debt stress or coping strategies. Good for a lightweight check-in, but lacks the structured savings/debt/coping-behavior breakdown QuestionPunk's template provides.

What it does well

  • Fast, low-friction form intended to be completed in a few minutes
  • Standard Jotform drag-and-drop builder with mobile-friendly layouts
  • Likely easy to embed or share via link for quick pulse checks

Where it falls short

  • Static question set with no adaptive AI follow-up to probe individual financial situations further
  • No automated per-response quality scoring or AI-generated report synthesis
  • No voice-based interview option or guided screen-share task capability

Ready to launch?

Open this template in the editor. Every part is yours to change before the first respondent sees it.

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