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Template

Survey Questionnaire Template

A general survey questionnaire combining profile, multiple-choice, rating and open-ended questions for research or market study.

SURVEY QUESTIONNAIRE

A structured questionnaire to gather responses for a survey or research study; responses are used only for the stated purpose and kept confidential.

Survey Title: [Survey Title]
Purpose: [Brief statement of what the survey aims to find out]
Date: [DD/MM/YYYY]

Section A - Respondent Profile
Name (optional): [Name]    Age Group: [ <25 ] [ 25-40 ] [ 41-60 ] [ 60+ ]
Gender: [ Male ] [ Female ] [ Other ]    City/State: [Location]
Occupation: [Occupation]

Section B - Multiple Choice
Q1. [Question]? [ Option A ] [ Option B ] [ Option C ] [ Option D ]
Q2. How often do you [activity]? [ Daily ] [ Weekly ] [ Monthly ] [ Rarely ] [ Never ]

Section C - Rating (1 = Strongly Disagree, 5 = Strongly Agree)
Q3. [Statement]: [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ]
Q4. [Statement]: [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ]

Section D - Open Ended
Q5. [Open question]? [Your Answer]
Q6. Any suggestions? [Your Answer]

Thank you for participating. Your responses are confidential and used only for [Purpose].

How to use: Keep the purpose statement short, mix closed and open questions, and place demographic questions first. Assure confidentiality to improve the response rate.

Before you use it — fill in / check

  • Survey Title
  • Target Respondent
  • Questions / Topic
  • Date

How to use this template

  1. Read through and replace every [bracketed] or blank placeholder with your actual details.
  2. Delete any clause that doesn't apply and add anything specific to your situation.
  3. Click Print / Save as PDF to download, or Copy text to paste into your letterhead.
  4. Get it signed / stamped / notarised as required, and keep a copy for your records.

This is a general, editable template for convenience only — not legal advice. For anything material, have a professional review it. TaxClue isn't liable for how it's used.