Questionnaire Template

We would like to know your views on ...........
There is a section at the end of the questionnaire for you to send us any comments.
Thanks for your help.

Background information

What country do you live in?:

Sex

Age :


This questionnaire consists of statements describing how ..........
Show how much you agree or disagree with each statement by selecting a number on the scale.
Don't spend too long over any one statement; just give your first reaction Questions about ..................

A1. What is your view about .......................

  1. Totally agree
  2. Somewhat agree
  3. Neither agree or disagree
  4. Somewhat disagree
  5. Totally disagree

A2. What is your view about .......................

  1. Totally agree
  2. Somewhat agree
  3. Neither agree or disagree
  4. Somewhat disagree
  5. Totally disagree

Any comments?


completed questionnaire to remote computer.