< Browse the Survey Templates + Write another survey

Mid-Point Review (6-8 Weeks)

Preview the Survey
+ Add to Projects
Show/Hide Guidance
X - Close

Makerble® Strategies

Discover insights you never had time to find

Interval Icon Interval Versions
Master Survey

Master Survey

Collect Responses

Collect Responses

Response Rates

Response Rates

Analyse Results

Analyse Results

Series Analysis

Series Analysis

About

Uploaded by: Makerble Templates

Mental Wellbeing & Symptoms

Q2. I’ve been feeling optimistic about the future (single choice)

Question Settings ▼ ▲

Hide this question

None of the time Rarely Some of the time Often All of the time
1 2 3 4 5

Dropdown List used: Answers: None,Rarely,Some,Often,All

Q3. I’ve been feeling cheerful (single choice)

Question Settings ▼ ▲

None of the time Rarely Some of the time Often All of the time
1 2 3 4 5

Dropdown List used: Answers: None,Rarely,Some,Often,All

Q4. I’ve been feeling relaxed (single choice)

Question Settings ▼ ▲

None of the time Rarely Some of the time Often All of the time
1 2 3 4 5

Dropdown List used: Answers: None,Rarely,Some,Often,All

Q5. I’ve been dealing with problems well (single choice)

Question Settings ▼ ▲

None of the time Rarely Some of the time Often All of the time
1 2 3 4 5

Dropdown List used: Answers: None,Rarely,Some,Often,All

Q6. I've been thinking clearly (single choice)

Question Settings ▼ ▲

None of the time Rarely Some of the time Often All of the time
1 2 3 4 5

Dropdown List used: Answers: None,Rarely,Some,Often,All

Q7. I’ve been feeling close to other people (single choice)

Question Settings ▼ ▲

None of the time Rarely Some of the time Often All of the time
1 2 3 4 5

Dropdown List used: Answers: None,Rarely,Some,Often,All

Q8. I’ve been able to make up my own mind about things (single choice)

Question Settings ▼ ▲

None of the time Rarely Some of the time Often All of the time
1 2 3 4 5

Dropdown List used: Answers: None,Rarely,Some,Often,All

Q9. I have felt tense, anxious or nervous (single choice)

Question Settings ▼ ▲

Not at all Only occasionally Sometimes Often Most or all of the time
Not at all 0 Only occasionally 1 Sometimes 2 Often 3 Most or all of the time 4

Dropdown List used: I have felt tense, anxious or nervous

Q10. I have felt I have someone to turn to for support when needed (single choice)

Question Settings ▼ ▲

Not at all Only occasionally Sometimes Often Most or all of the time
Not at all 0 Only occasionally 1 Sometimes 2 Often 3 Most or all of the time 4

Dropdown List used: I have felt tense, anxious or nervous

Q11. I have felt able to cope when things go wrong (single choice)

Question Settings ▼ ▲

Not at all Only occasionally Sometimes Often Most or all of the time
Not at all 0 Only occasionally 1 Sometimes 2 Often 3 Most or all of the time 4

Dropdown List used: I have felt tense, anxious or nervous

Q12. Talking to people has felt too much for me (single choice)

Question Settings ▼ ▲

Not at all Only occasionally Sometimes Often Most or all of the time
Not at all 0 Only occasionally 1 Sometimes 2 Often 3 Most or all of the time 4

Dropdown List used: I have felt tense, anxious or nervous

Q13. I have felt panic or terror (single choice)

Question Settings ▼ ▲

Not at all Only occasionally Sometimes Often Most or all of the time
Not at all 0 Only occasionally 1 Sometimes 2 Often 3 Most or all of the time 4

Dropdown List used: I have felt tense, anxious or nervous

Q14. I have made plans to end my life (single choice)

Question Settings ▼ ▲

Not at all Only occasionally Sometimes Often Most or all of the time
Not at all 0 Only occasionally 1 Sometimes 2 Often 3 Most or all of the time 4

Dropdown List used: I have felt tense, anxious or nervous

Q15. I have had difficulty getting to sleep or staying asleep (single choice)

Question Settings ▼ ▲

Not at all Only occasionally Sometimes Often Most or all of the time
Not at all 0 Only occasionally 1 Sometimes 2 Often 3 Most or all of the time 4

Dropdown List used: I have felt tense, anxious or nervous

Q16. I have felt despairing or hopeless (single choice)

Question Settings ▼ ▲

Not at all Only occasionally Sometimes Often Most or all of the time
Not at all 0 Only occasionally 1 Sometimes 2 Often 3 Most or all of the time 4

Dropdown List used: I have felt tense, anxious or nervous

Q17. I have felt unhappy (single choice)

Question Settings ▼ ▲

Not at all Only occasionally Sometimes Often Most or all of the time
Not at all 0 Only occasionally 1 Sometimes 2 Often 3 Most or all of the time 4

Dropdown List used: I have felt tense, anxious or nervous

Q18. Unwanted images or memories have been distressing me (single choice)

Question Settings ▼ ▲

Not at all Only occasionally Sometimes Often Most or all of the time
Not at all 0 Only occasionally 1 Sometimes 2 Often 3 Most or all of the time 4

Dropdown List used: I have felt tense, anxious or nervous

Coping & Self-Management

Q20. Coping Skills Confidence (single choice)

Question Settings ▼ ▲

How confident are you using coping strategies when you're struggling?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Knows Neighbors

Q21. Can Identify Triggers (single choice)

Question Settings ▼ ▲

How well can you identify what triggers your difficult feelings or thoughts?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Knows Neighbors

Q22. Can Ask for Help (single choice)

Question Settings ▼ ▲

How comfortable are you asking for help when you need it?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Knows Neighbors

Q23. Has Self-Care Routine (single choice)

Question Settings ▼ ▲

How consistently do you practice self-care activities that help your wellbeing?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Knows Neighbors

Hope & Recovery

Q25. Hope for Recovery (single choice)

Question Settings ▼ ▲

How hopeful do you feel about your recovery and future?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Knows Neighbors

Q26. Belief in Ability to Cope (single choice)

Question Settings ▼ ▲

How much do you believe you can cope with challenges in your life?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Knows Neighbors

Q27. Sense of Control (single choice)

Question Settings ▼ ▲

How much control do you feel you have over your mental health?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Knows Neighbors

Social Connection

Q29. Social Connection (single choice)

Question Settings ▼ ▲

How connected do you feel to other people (friends, family, community)?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Knows Neighbors

Q30. Reduced Loneliness (single choice)

Question Settings ▼ ▲

How often do you feel lonely?

1 2 3 4 5 6 7 8 9 10
Always Never

Dropdown List used: Knows Neighbors

Q31. Has Support Network (single choice)

Question Settings ▼ ▲

Do you have people you can turn to for support when needed?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Knows Neighbors

Goals

Q33. How much progress do you feel you've made since starting? (single choice)

Question Settings ▼ ▲

How much progress do you feel you've made since starting?

1 2 3 4 5 6 7 8 9 10
Not at all Life-changing

Dropdown List used: Knows Neighbors

Q34. What's been most helpful so far? (Text)
This question will appear once within your story or survey response.

Q35. Is there anything we should do differently? (Text)
This question will appear once within your story or survey response.

Q36. Do you feel you're on track to meet your goals? (single choice)

Question Settings ▼ ▲

Do you feel you're on track to meet your goals?

Yes Somewhat No

Dropdown List used: Do you feel you're on track to meet your goals?

Collect survey responses

360°
360°
Invite observers to answer a survey about a contact in your CRM. Send out invitations for several contacts at once via email, SMS or your own channels.

Collect Responses

Universal
Universal
Allow anyone with the link to submit a survey response.
Optionally generate a QR code.
Share Link

Tracked
Tracked
Track responses to individual contacts. Send survey invitations via email and SMS - with automated reminders - or your own communication channels.
Collect Responses

Anonymised
Anonymised
Hide the identity of each respondent when collecting responses from saved contacts or a list of email addresses.
Collect Responses

Import
Import
Upload survey responses from a spreadsheet with a row per respondent and column per question.
Import Responses

API
API
Send out survey invitations programmatically and/or receive responses via the API..
Get Started

Type Up: 1 at a time
Type Up: 1 at a time
Submit a survey response about a saved contact while filling in a survey in-person (CAPI), over the phone (CATI) or typing up a paper survey response.
Collect Response

Type Up: Several at once
Type Up: Several at once
Use the Answers Table to submit responses to each question. There’s one row per contact. Responses are automatically linked to individual contacts.
Enter Responses

Type Up: Manual Headcount
Type Up: Manual Headcount
Enter responses without the need for individual contacts or respondents. Enter the number of people who gave each answer to each question.
Enter Quantities

Universal Manual Headcount
Universal Manual Headcount
Collect manual headcount responses from anyone with the link.

Share Link

Multi-stage
Multi-stage
Collect demographic data. Thread several surveys together. Deliver advanced survey experiences.
Go to Signup Pages

Branded Portal
Branded Portal
Provide respondents with a password-protected space to submit, review, discuss or act upon survey responses.
Get Started

Automation
Automation
Automatically send out survey invitations whenever certain rules are met
Create an automation

X
Close

Adjust When

Step 1: Where will this adjustment be applied?

Step 2: When will this adjustment be applied?

Step 3: Who does this adjustment apply to?

Choose whether to show, hide or reword this question based on where, when and by whom the survey is completed