Sample Questionnaire Form

Forms are increasingly being used as viable mode of questionnaires. They are easy to use in open-ended questionnaires, since they provide the respondent with enough space to write their opinions. They also contain close ended questions where the respondent answers using agree or disagree with a statement. Alternatively, the respondent is required to pick from different choices of answers. They are mainly used in surveys to gauge customer or employee satisfaction. Forms are ideal for use on Internet based questionnaires since they contain elements such as text-area fields, radio buttons, drop-down menus, radio button and expandable text boxes among others.

Below is an example.

Bank XYZ Sample Questionnaire Form

Your account with bank XYZ is located at

Have you been to your account branch in the past 6 months?



Rate the following services as either

Very satisfying



  1. i.      Services offered in the bank
  2. ii.      The attendants knowledge on services and products offered by the bank
  3. iii.      The bank’s staff willingness to listen and assist
  4. iv.      The speed of attending to your needs by the bank’s staff members
  5. v.      The speed of issuing checks
  6. vi.      Professionalism in handling transactions
  7. vii.      Effective communication
  8. viii.      Professionalism in dressing
  9. ix.      Courtesy and friendliness
  10. x.      Availability

How many times do you contact your branch in a year?

At least 1 to 3 times_______________

At least five times________________

Uncountable times________________

What is your preferred mode of contacting your branch?

By telephone_________________________

Through email________________________

Going to my branch physically___________

Does the branch always grant you your request?

For what reasons do you most contact your account branch?

Account balance____________________

Loan inquiry_______________________


Confirming fund transfers____________

Inquiries about my credit card_________

Other reasons (specify) ______________


Category: Questionnaire Writing

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