RESEARCH

Study screener + consent survey template

A draft consent gate, a working eligibility branch, and an attention item for a study of online-shopping experiences.

8 questions · 3 pages · 3 answer formats · About 1 min

Time is estimated from all questions, including matrix rows. Branching can shorten a path; reading, consent and longer written answers can add time. Confirm it with a pilot.

Advanced logic
Consent gate
Screening
Attention check
Pro to publish

Use this template →Try the survey Read every question

Free to preview and customize. Publishing this template with its configured advanced features requires Pro.

Use this template opens an editable draft after sign-in. Questions, answer options and configured logic carry over; nothing is published until you choose to publish.

Try the questionnaire

Answer it before you use it.

Try the actual questions, follow-ups and endings. Preview answers stay in this tab and disappear when you close or restart it. Nothing is submitted.

Who this is for

Researchers recruiting adults with recent online-shopping experience for a follow-up study.

Before you send it

Replace the draft consent text with your study information and contact details. This example screens out people with no online purchases in the past 30 days. Adapt that rule, age eligibility, and panel endings before launch.

Questionnaire preview

These are the questions and answer options copied into your draft. Bracketed text is a prompt to customize. Matrix questions contain several statements, so allow time for each row.

Consent gate before the questions

[Researcher: replace this draft with your study information.] Explain the purpose, tasks, expected time, compensation (if any), risks, data use, withdrawal limits, and a researcher contact. Taking part is voluntary. You may decline before starting.

Declining the gate exits without submitting a response. Replace the draft information before publishing.

How this template adapts

A consent gate, two eligibility checks, and an attention signal provide a working recruitment example.

Declining consent exits before the questionnaire without submitting a response.
Never shopping online screens out on page 1. Under 18 screens out after the experience page.
The attention check flags an incorrect answer for review; it does not automatically reject someone. An omitted age or Prefer not to say does not screen out.

Test the setup before sharing

Try declining consent, Never, Under 18, and an eligible adult path.
Set your own eligibility policy, consent wording, panel completion settings, and review policy before launch.

The preview below lists every possible question. Respondents see only the questions on their path. Open this template in the builder to test it with live answers.

Page 1

1. In the last 30 days, how often did you shop online? (required)
Choose one
Never1–2 times3–5 times6+ times
Page 2: Your experience
2. Which age group are you in?
Choose one
Under 1818–2425–3435–4445–5455+Prefer not to say
3. To show you are reading, please select 'Disagree' below. (required)
Choose one
Strongly agreeAgreeDisagreeStrongly disagree
4. How confident are you using a computer for everyday tasks?
Choose one
Not at allSlightlyModeratelyVery
Page 3: Context and next steps
5. Which devices have you used to shop online in the last 30 days?
Choose all that apply
PhoneTabletLaptop or desktopAnother device
6. How do you usually decide what to buy online?
Choose one
Mostly on my ownWith someone elseSomeone else usually decidesIt depends
7. What kind of item did you most recently buy online? Please do not include order numbers or personal details.
Short text
8. How would you prefer to complete a follow-up research session?
Choose one
Video callIn personUnmoderated online taskI am not interested

Use this template →

Use the builder link to retain logic, piping, consent, scoring, and randomization. Plain text copies wording only; piped answers become editable placeholders.

How to read the results

Inspect the eligibility rate and verify the panel IDs in a test export. The attention item is configured as a quality signal; decide your review policy in advance rather than treating every failure as an automatic exclusion.

Preview your edited survey on desktop and mobile, run a small pilot, and review an export before inviting the full audience. Adding questions is optional: keep the ones that support your decision.