Running a survey with participants in the EU or EEA means being able to show that each person agreed to take part and understood how their data would be used. This survey consent form puts that agreement up front: respondents give their name, email, and country of residence, then check a required consent box before they answer anything else.
After the core consent, participants choose additional permissions one by one, such as being contacted with follow-up questions, receiving a summary of the results, or hearing about future research. Keeping these as separate choices instead of one bundled agreement reflects the GDPR idea that consent should be specific. The survey section that follows covers satisfaction, a 1 to 10 recommendation score, suggested improvements, and feature usage, and is meant to be replaced with your own questions.
Demographic questions are opt-in. Respondents are asked whether they want to share demographic details, and only those who say yes see questions about age range, gender, occupation sector, and education. The form ends with research participation preferences, topics of interest, and a confirmation that the information provided is accurate.
Treat this template as a starting point rather than legal advice. Add your privacy notice, name the organization responsible for the data, and check the wording with whoever handles data protection for you before you launch.
