21-Day Wellness Challenge Survey Template

Preview on a device

21-Day Wellness Challenge Survey Preview

Use this 21-day wellness challenge survey template to learn how participants experienced your program and what made it easier or harder to take part. The eight questions cover participation, instructions, support, and suggestions for the next challenge. You can adapt the questionnaire in SurveyLegend without asking people to share weight, diagnoses, or other private health details.

When to use this 21-day wellness challenge survey

Send the survey when your 21-day program ends, including to people who joined but stopped participating. Their answers can reveal obstacles that a survey of finishers would miss. Explain which challenge you mean and how you will use the feedback. This version evaluates the program experience; it does not measure health improvement or determine whether someone has formed a habit. For a one-off gathering instead, use our post-event survey template .

8 questions for your 21-day wellness challenge survey

Start with these questions and adapt them to your audience. Every field is optional. Where answer choices are listed, respondents choose one.

Respondent introduction:
Please think about the 21-day challenge that has just ended. We want to understand the program experience, including what made it difficult to take part. All questions are optional. Please avoid private health details.

How to customize your 21-day wellness challenge survey

Add the challenge name and dates to the introduction. Replace general references to activities with the activities you actually offered, while keeping participation voluntary. Avoid presenting completion as the only successful outcome: someone may have found a useful activity without following the whole schedule. Keep contact requests separate from feedback, and explain who will read responses. Try the questions with a few participants before sending the survey to everyone.

Printable 21-day wellness challenge survey template

Use this printable 21-day wellness challenge survey template at your final session or give it to participants who prefer answering on paper. It offers the same program-feedback questions with space to write. SurveyLegend helps you offer an online questionnaire and a paper option, so participants can choose the format that suits them.

AI prompt for a 21-day wellness challenge survey

Create a 21-day wellness challenge survey in SurveyLegend with questions about participation, instructions, support, and practical barriers.

The full prompt below includes all 8 questions and their response settings. Copy it, register for a free SurveyLegend account, and paste it into SurveyLegend's AI survey creation tool. Review and customize the result before sharing.

Create a 21-day wellness challenge survey in SurveyLegend using the exact questionnaire below.

Purpose: Understand participation and practical barriers after a 21-day program.

Requirements:
- Include exactly 8 questions or fields, in the order shown. Preserve the wording, answer choices, choice order, field types, and optional settings verbatim.
- Use one selection for each Single choice field. Show all fields. Preserve instructions about leaving an irrelevant field blank; do not invent automatic branching.
- Do not add scoring, sample answers, claims of validation, or an anonymity promise.
- Keep the respondent introduction below. Any named event, advertisement, use case, review period, or organization referenced must be supplied by the survey creator before sharing. Do not invent these details.
- If a field, setting, or required supporting asset cannot be provided, explain the limitation. Do not silently substitute it or claim a working survey exists.

Respondent introduction:
Please think about the 21-day challenge that has just ended. We want to understand the program experience, including what made it difficult to take part. All questions are optional. Please avoid private health details.

Exact questionnaire:

1. During the 21-day challenge, how often did you take part in the activities you chose?
Field type: Single choice
Answer choices, in order:
- Every day
- Most days
- Some days
- A few days
- I did not take part
Required: No

2. How clear were the instructions for getting started?
Field type: Single choice
Answer choices, in order:
- Not at all clear
- Slightly clear
- Moderately clear
- Very clear
- Extremely clear
- I did not read the instructions
Required: No

3. How well did the activity schedule fit your daily routine?
Field type: Single choice
Answer choices, in order:
- Not at all well
- Slightly well
- Moderately well
- Very well
- Extremely well
- I did not follow a schedule
Required: No

4. Which activity, if any, would you choose to do again?
Field type: Long text
Answer choices: none; respondent enters their own text.
Required: No

5. What made it difficult to participate? Please avoid private health details.
Field type: Long text
Answer choices: none; respondent enters their own text.
Required: No

6. How useful was the support available during the challenge?
Field type: Single choice
Answer choices, in order:
- Not at all useful
- Slightly useful
- Moderately useful
- Very useful
- Extremely useful
- I did not use the support
Required: No

7. What should we keep for the next challenge?
Field type: Long text
Answer choices: none; respondent enters their own text.
Required: No

8. What is one change that would make the next challenge easier to take part in?
Field type: Long text
Answer choices: none; respondent enters their own text.
Required: No

Before finishing, compare every field with this specification. Report differences separately. Let the creator review and customize the private draft before sharing; do not publish it automatically.

Use prompt directly in SurveyLegend

Create a free account, then paste the copied prompt into SurveyLegend.

Already have an account? Sign in to create your 21-day wellness challenge survey.

Use challenge feedback to improve participation

Start with participation patterns, then read the comments about timing, instructions, and support. Compare the experiences of people who participated often with those who participated less, without treating either group as more credible. Choose one practical change, such as simpler instructions or a more flexible schedule, and tell participants what you plan to do. Survey feedback alone cannot show that the program caused a change in health.

When should I send a wellness challenge survey?

Send it shortly after the challenge ends, while the activities are still easy to remember. Invite everyone who enrolled, including people who did not finish. If you want feedback during the challenge, shorten the questionnaire and use it as a separate check-in.

Should I ask participants about weight loss?

This template focuses on the program experience and does not ask for weight or medical information. Keep questions relevant to decisions you can make about the challenge. Do not add personal health questions simply because the program is about wellness.

Does a 21-day challenge prove a habit has formed?

No. This questionnaire asks people to describe participation and their experience. It does not test habit formation. Treat plans to continue an activity as intentions, and use a separate later check-in if you want to learn what participants actually continued.

Healthcare and Hospital Survey Templates

21-Day Wellness Challenge Survey Template

When to use this 21-day wellness challenge survey

8 questions for your 21-day wellness challenge survey

A little feedback. A clearer picture.