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1
Radio; How many times per week do you feel tired during the day?
Once a week
Two days a week
Three or four days a week
Five or six days a week
Every day
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2
Checkbox; How many times per week do you feel tired during the day?
Once a week
Two days a week
Three or four days a week
Five or six days a week
Every day
Other:
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3
Scale; What grade would you give your health??
1
2
3
4
5
6
7
8
9
10
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4
Open text long; Do you have any questions regarding your health?
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5
Open text short; What is your name?
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6
Open text numeric; How tall are you in cm?
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7
Select; Where do you live?
Netherlands
Germany
Belgium
United States
Mexico
Brazil
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8
Statement selection; Select the answer that describes you best
Statement 1
I always get distracted during work
I sometimes get distracted during work
I never get distracted during work
Statement 2
I always get distracted during work
I sometimes get distracted during work
I never get distracted during work
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9
Matrix; For each of the statement, select how much you agree
Completely disagree
Mostly disagree
Slightly disagree
Don't really have an opinion
Somewhat agree
Mostly agree
Completely completely agree
I need more information
I can't answer this
I have so many questions
I am convinced we are living in the matrix
Star Wars of obviously better than Star Trek
I think, therefor I am
This is the best statement ever made by a human
Questio Care is the best SaaS product for taking questionnaires
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10
Date; what is your birthdate?
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