Longitudinal Survey Data Collection Survey Form
Use this form to collect repeat survey responses over time, including respondent tracking details, the current wave, the reference period, longitudinal measures, and follow-up preferences. Longitudinal Survey Data Collection Survey Form.
Respondent Identification
Respondent ID or participant code
*
Full name
*
First Name
Last Name
Email address for follow-up
example@example.com
Survey Wave and Timing
Survey wave number
*
Survey date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reference period covered by your answers
*
Longitudinal Measures
Baseline / current status and change since last survey wave
*
Rows
Baseline / current status
Change since last survey wave
Overall well-being
1
2
Physical health
3
4
Mental health
5
6
Work or study performance
7
8
Daily functioning
9
10
Frequency over the reference period
*
Never
Rarely
Sometimes
Often
Very often
Overall rating of the topic being studied
*
Very poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Very poor, 10 is Excellent
Follow-up Preferences
Preferred follow-up method
*
Email
Phone
No follow-up
Additional notes or comments
Submit
Should be Empty: