Example Psychological Survey
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A red asterisk (*) indicates required questions.

  1. How many cans/bottles of soda do you drink in an average week?*
    I don't normally drink soda
    About 1-2
    About 3-4
    About 5-6
    About 7-8
    About 9-10
    About 11-12
    About 13-14
    About 15-16
    About 17-18
    About 19-20
    About 21-22
    About 23-24
    25+


  1. How many cups of coffee do you drink in an average week?*
    I don't normally drink coffee
    About 1-2
    About 3-4
    About 5-6
    About 7-8
    About 9-10
    About 11-12
    About 13-14
    About 15-16
    About 17-18
    About 19-20
    About 21-22
    About 23-24
    25+


  1. How many hours do you sleep per night, on average?*
    Less than 1
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    11
    12+


  1. On a scale from 1-5, with 5 being the most energetic, how energetic are you in an average day?*
    1 - Not energetic at all
    2
    3
    4
    5 - Extremely energetic


  1. On a scale from 1-5, with 5 being the most happy, how happy are you in an average day?*
    1 - Not happy at all
    2
    3
    4
    5 - Extremely happy





Mr. Nisavic
Social Studies Teacher
Alan B. Shepard High School
IL