Double-Blind Research Survey Form
Complete this double-blind research survey using the same title throughout the form. The survey is designed to capture participant responses and session context while preserving blind conditions.
Participant and Study Context
Participant code or alias
*
Age range
Under 18
18–24
25–34
35–44
45–54
55–64
65+
Study session date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Study version / condition code
*
Please Select
A
B
C
D
Other
Blind Survey Responses
Perceptions and Agreement
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The study task was clear
1
2
3
4
5
The materials were easy to understand
6
7
8
9
10
The questions felt relevant to the topic
11
12
13
14
15
I felt confident in my responses
16
17
18
19
20
Assigned Condition / Blind Group
Group A
Group B
Control Group
Not Sure
Overall Experience
*
1
2
3
4
5
Comments or Observations
Session Notes and Completion
Completion Status
*
Completed
Partially completed
Unable to complete
Study Feedback
Follow-up Note
Submit
Should be Empty: