--- generated_by: surveylegend-page-markdown title: 21-Day Wellness Challenge Survey | SurveyLegend description: Collect feedback on a 21-day wellness challenge. Adapt questions about participation, support, and barriers to improve your next program. canonical: https://www.surveylegend.com/survey-examples-templates/healthcare-and-hospital-surveys/21-day-wellness-challenge-template/ --- # 21-Day Wellness Challenge Survey Template [Create your survey ](https://app.surveylegend.com/register/)[Try the survey](https://www.surveylegend.com/survey-examples-templates/healthcare-and-hospital-surveys/21-day-wellness-challenge-template/#try-template) Preview on a device Show the desktop survey preview Show the tablet survey preview Show the mobile survey preview ![21-Day Wellness Challenge Survey: first question and response field, desktop preview](https://www.surveylegend.com/survey-template-media/previews/21-day-wellness-challenge-demo-preview.avif) ![21-Day Wellness Challenge Survey: first question and response field, tablet preview](https://www.surveylegend.com/survey-template-media/previews/21-day-wellness-challenge-demo-preview-tablet.avif) ![21-Day Wellness Challenge Survey: first question and response field, mobile preview](https://www.surveylegend.com/survey-template-media/previews/21-day-wellness-challenge-demo-preview-phone.avif) 21-Day Wellness Challenge Survey [Preview](https://www.surveylegend.com/survey-examples-templates/healthcare-and-hospital-surveys/21-day-wellness-challenge-template/#try-template) Share [Facebook ](https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fhealthcare-and-hospital-surveys%2F21-day-wellness-challenge-template%2F)[LinkedIn ](https://www.linkedin.com/sharing/share-offsite/?url=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fhealthcare-and-hospital-surveys%2F21-day-wellness-challenge-template%2F)[X ](https://x.com/intent/tweet?url=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fhealthcare-and-hospital-surveys%2F21-day-wellness-challenge-template%2F\&text=21-Day%20Wellness%20Challenge%20Survey%20Template)[Reddit](https://www.reddit.com/submit?url=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fhealthcare-and-hospital-surveys%2F21-day-wellness-challenge-template%2F\&title=21-Day%20Wellness%20Challenge%20Survey%20Template) 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 ](https://www.surveylegend.com/survey-examples-templates/post-event-survey-template/). **Create your 21-day wellness challenge survey in SurveyLegend** Collect feedback on a 21-day wellness challenge. Adapt questions about participation, support, and barriers to improve your next program. ## 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. Try the survey ## A little feedback. A clearer picture. Explore this 8-question example at your own pace. Every question is optional. Preview on a device Show the survey at full desktop width Resize the survey to a tablet-width preview Resize the survey to a mobile preview with scrolling inside the frame Choose a look Use Classic: a white survey card over the background photo Use Light: dark text over a light tint covering the background photo Use Dark: light text over a dark tint covering the background photo SurveyLegend demo Question 1 of 8 ### 21-Day Wellness Challenge Survey 01 During the 21-day challenge, how often did you take part in the activities you chose? Choose one answer, or skip this question. Every day Most days Some days A few days I did not take part 02 How clear were the instructions for getting started? Choose one answer, or skip this question. Not at all clear Slightly clear Moderately clear Very clear Extremely clear I did not read the instructions 03 How well did the activity schedule fit your daily routine? Choose one answer, or skip this question. Not at all well Slightly well Moderately well Very well Extremely well I did not follow a schedule 04 Which activity, if any, would you choose to do again? Share your answer, or skip this question. 05 What made it difficult to participate? Please avoid private health details. Share your answer, or skip this question. 06 How useful was the support available during the challenge? Choose one answer, or skip this question. Not at all useful Slightly useful Moderately useful Very useful Extremely useful I did not use the support 07 What should we keep for the next challenge? Share your answer, or skip this question. 08 What is one change that would make the next challenge easier to take part in? Share your answer, or skip this question. #### One last look Review your answers before submitting this demo. 0 answered #### Thank you for trying the survey! You’ve tried the template from the respondent’s side. Make it your own with SurveyLegend. [Create your own survey](https://www.surveylegend.com/register/) Checking submission availability… This is a demo. We count starts and submissions only. Your answers stay in your browser and are never sent or saved. **—**Starts **—**Submissions Activity is temporarily unavailable. ## 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. [![](https://www.surveylegend.com/user-guide-media/icons/download-pdf.svg) Download PDF](https://www.surveylegend.com/downloads/survey-templates/21-day-wellness-challenge-template.pdf) Export 21-day wellness challenge survey template as PDF ## 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. AI prompt for a 21-day wellness challenge survey [Use prompt directly in SurveyLegend](https://www.surveylegend.com/register/) 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.](https://app.surveylegend.com/login/) ## 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. ## Frequently asked questions ### 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 1. [![Preview of the Healthcare CAHPS® Visit Survey 2.0 Survey Template](https://www.surveylegend.com/survey-template-media/previews/template-healthcare-cahps-visit-survey-template-survey-preview.avif) Healthcare CAHPS® Visit v2.0 Survey Template Healthcare When a patient chooses to enter your hospital, the quality of the treatment they are going to receive is the most important thing. To reach a high quality in the treatment, several aspects have to be taken into consideration. Everything from the first contact with the hospital staff, to the behavior of the doctor the patient visited.](https://www.surveylegend.com/survey-examples-templates/healthcare-cahps-visit-survey-template/) 2. 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[![Preview of the Healthcare CAHPS® Health Plan v4.0 Survey Template](https://www.surveylegend.com/survey-template-media/previews/template-healthcare-cahps-health-plan-survey-template-survey-preview.avif) Healthcare CAHPS® Health Plan v4.0 Survey Template Healthcare Understanding how patients perceive their health plans is critical for every forward-thinking hospital, clinic, or healthcare network. With rising expectations and increasing competition, it’s no longer enough to simply offer care — patients expect transparency, convenience, and personalized service.](https://www.surveylegend.com/survey-examples-templates/healthcare-cahps-health-plan-survey-template/) Free survey maker ## Start creating surveys today *for free* Create and bring your ideas to life with the survey tool used by people all over the world. 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[Start free](https://app.surveylegend.com/register/) to create your wellness challenge survey and plan a more practical next program. [*Self-serve* Start free Create your first survey in minutes **Start free** ](https://app.surveylegend.com/register/)[*Guided help* Book a demo Talk with a SurveyLegend expert and choose the right plan. **Book a demo**](https://www.surveylegend.com/schedule-a-demo-of-surveylegend/)