About this template
This comprehensive Internet Addiction Disorder survey template is designed to investigate, measure, and analyze digital habits among students and youth. It helps educators, school counselors, researchers, and parents gain actionable insights into daily screen time, online behaviors, and the potential psychological impacts of excessive internet use.
The questionnaire captures critical behavioral indicators such as difficulty logging off, preference for online interactions over real-world relationships, loss of sleep due to late-night browsing, and changes in academic or daily performance. By gathering structured data across these dimensions, schools and support teams can raise awareness, identify early warning signs, and develop targeted digital wellness interventions.
Whether you are conducting academic research, designing school-wide wellness programs, or evaluating youth technology habits at home, this ready-to-use Google Form streamlines data collection. It provides a clear, organized format that protects respondent context while delivering clean data ready for analysis.
Key features
- Assess daily screen time and primary online activities easily
- Evaluate behavioral indicators of compulsive internet usage
- Capture demographic and school environment details
- Ready-to-use template designed for educators and researchers
- Instantly convert into a live Google Form with Doc2Form
Use cases
- School-wide student digital wellness and screen time assessments
- Academic research projects on youth technology and internet habits
- Parent-teacher association workshops on healthy device management
- Counseling department intake and behavioral screening initiatives
What this form collects
- Respondent Status (Multiple choice)Select your primary role regarding this survey.
- Name Initials (Short answer)Please enter your first and last name initials for reference.
- Date of Birth (Date)Enter your date of birth.
- Gender (Multiple choice)Select your gender identity.
- Daily Internet Hours (Last 2 Months) (Dropdown)On average, how many hours per day do you spend online outside of mandatory school or work tasks?
- Main Internet Use (Checkboxes)What do you primarily use the internet for?
- Do you find yourself staying online longer than intended? (Multiple choice)Choose the option that best describes your experience.
- Do you neglect offline responsibilities or leisure to spend time online? (Multiple choice)Chores, hobbies, or offline social activities.
- Do you prefer online relationships over real-life interactions? (Multiple choice)Feeling more comfortable talking to people online than in person.
- Do others complain about the amount of time you spend online? (Multiple choice)Family members, friends, or teachers.
- Do your grades or schoolwork suffer because of time spent online? (Multiple choice)Decline in academic performance or missed assignments.
- Do you lose sleep due to late-night online logins? (Multiple choice)Staying up past your planned bedtime to browse or chat.
- Do you feel depressed, moody, or nervous when you are offline? (Multiple choice)Mood changes when internet access is unavailable.
- Additional Comments & Feedback (Paragraph)Please share any additional thoughts or suggestions regarding digital habits and screen time.
FAQ
How do I use this template with Google Forms?
Simply use Doc2Form to instantly convert this template into a fully functional Google Form in your Google Drive account.
Can I customize the questions in this survey?
Yes! Once the form is generated in your Google Workspace, you can freely add, remove, or edit any questions to match your exact research or institutional needs.
Is this template suitable for academic research?
Yes, the survey structure incorporates standard behavioral indicators used to assess compulsive internet habits and screen time impact among secondary students.
How are survey responses collected?
All responses flow directly into a connected Google Sheet, making it easy to analyze data, track trends, and generate summary reports.
Is it free to use this template?
Yes, Doc2Form allows you to convert this template into a Google Form at no cost.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.