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Section 1 of 1
Form title
Kratom Effects Survey
Form description
Please scroll through the kratom strains you have tried and rate the effects from 1 being a mild effect to 5 being a very strong effect.
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RED BORNEO
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Question
RED BORNEO
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Question Type
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Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Description
Loading image…
Caption
1
4
Option 4
5
Other…
Add option
or
add "Other"
…
Select at least
Select at most
Select exactly
Number
Custom error text
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(0 points)
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GREEN BORNEO
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Question
GREEN BORNEO
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Paragraph
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Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Description
Loading image…
Caption
1
2
3
4
Option 5
Option 6
Option 7
Option 8
Option 9
Other…
Add option
or
add "Other"
…
Select at least
Select at most
Select exactly
Number
Custom error text
Answer key
(0 points)
Require a response in each row
Required
Required
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WHITE BORNEO
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Question
WHITE BORNEO
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Paragraph
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Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Description
Loading image…
Caption
1
2
3
4
5
ENERGY
MOOD
RELIEF
STIMULATION
RELAXATION
Rows
1.
ENERGY
2.
MOOD
3.
RELIEF
4.
STIMULATION
5.
RELAXATION
1.
Other…
6.
Add row
or
add "Other"
Columns
1
2
3
4
5
Other…
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…
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GREEN MAENG DA
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Question
GREEN MAENG DA
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Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Description
Loading image…
Caption
1
2
3
4
5
RELIEF
Rows
1.
RELIEF
1.
Other…
2.
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Columns
1
2
3
4
5
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WHITE MAENG DA
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Question
WHITE MAENG DA
*
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Description
Loading image…
Caption
1
2
3
4
5
ENERGY
MOOD
RELIEF
STIMULATION
RELAXATION
Rows
1.
ENERGY
2.
MOOD
3.
RELIEF
4.
STIMULATION
5.
RELAXATION
1.
Other…
6.
Add row
or
add "Other"
Columns
1
2
3
4
5
Other…
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RED THAI
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Question
RED THAI
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Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Description
Loading image…
Caption
1
2
3
4
5
ENERGY
MOOD
RELIEF
STIMULATION
RELAXATION
Rows
1.
ENERGY
2.
MOOD
3.
RELIEF
4.
STIMULATION
5.
RELAXATION
1.
Other…
6.
Add row
or
add "Other"
Columns
1
2
3
4
5
Other…
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or
add "Other"
…
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GREEN THAI
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Question
GREEN THAI
*
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Description
Loading image…
Caption
1
2
3
4
5
ENERGY
MOOD
RELIEF
STIMULATION
RELAXATION
Rows
1.
ENERGY
2.
MOOD
3.
RELIEF
4.
STIMULATION
5.
RELAXATION
1.
Other…
6.
Add row
or
add "Other"
Columns
1
2
3
4
5
Other…
Add column
or
add "Other"
…
Answer key
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Require a response in each row
Required
Required
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WHITE THAI
*
Question
WHITE THAI
*
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Description
Loading image…
Caption
1
2
3
4
5
ENERGY
MOOD
RELIEF
STIMULATION
RELAXATION
Rows
1.
ENERGY
2.
MOOD
3.
RELIEF
4.
STIMULATION
5.
RELAXATION
1.
Other…
6.
Add row
or
add "Other"
Columns
1
2
3
4
5
Other…
Add column
or
add "Other"
…
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RED INDO
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Question
RED INDO
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Dropdown
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Multiple choice grid
Checkbox grid
Date
Time
Description
Loading image…
Caption
1
2
3
4
5
ENERGY
MOOD
RELIEF
STIMULATION
RELAXATION
Rows
1.
ENERGY
2.
MOOD
3.
RELIEF
4.
STIMULATION
5.
RELAXATION
1.
Other…
6.
Add row
or
add "Other"
Columns
1
2
3
4
5
Other…
Add column
or
add "Other"
…
Answer key
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Require a response in each row
Required
Required
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GREEN INDO
*
Question
GREEN INDO
*
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Description
Loading image…
Caption
1
2
3
4
5
ENERGY
MOOD
RELIEF
STIMULATION
RELAXATION
Rows
1.
ENERGY
2.
MOOD
3.
RELIEF
4.
STIMULATION
5.
RELAXATION
1.
Other…
6.
Add row
or
add "Other"
Columns
1
2
3
4
5
Other…
Add column
or
add "Other"
…
Answer key
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Require a response in each row
Required
Required
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WHITE INDO
*
Question
WHITE INDO
*
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Description
Loading image…
Caption
1
2
3
4
5
ENERGY
MOOD
RELIEF
STIMULATION
RELAXATION
Rows
1.
ENERGY
2.
MOOD
3.
RELIEF
4.
STIMULATION
5.
RELAXATION
1.
Other…
6.
Add row
or
add "Other"
Columns
1
2
3
4
5
Other…
Add column
or
add "Other"
…
Answer key
(0 points)
Require a response in each row
Required
Required
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RED BALI
*
Question
RED BALI
*
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Description
Loading image…
Caption
1
2
3
4
5
ENERGY
MOOD
RELIEF
STIMULATION
RELAXATION
Rows
1.
ENERGY
2.
MOOD
3.
RELIEF
4.
STIMULATION
5.
RELAXATION
1.
Other…
6.
Add row
or
add "Other"
Columns
1
2
3
4
5
Other…
Add column
or
add "Other"
…
Answer key
(0 points)
Require a response in each row
Required
Required
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GREEN BALI
*
Question
GREEN BALI
*
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Description
Loading image…
Caption
1
2
3
4
5
ENERGY
MOOD
RELIEF
STIMULATION
RELAXATION
Rows
1.
ENERGY
2.
MOOD
3.
RELIEF
4.
STIMULATION
5.
RELAXATION
1.
Other…
6.
Add row
or
add "Other"
Columns
1
2
3
4
5
Other…
Add column
or
add "Other"
…
Answer key
(0 points)
Require a response in each row
Required
Required
Loading...
Loading…
GREEN MALAY
*
Question
GREEN MALAY
*
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Description
Loading image…
Caption
1
2
3
4
5
ENERGY
MOOD
RELIEF
STIMULATION
RELAXATION
Rows
1.
ENERGY
2.
MOOD
3.
RELIEF
4.
STIMULATION
5.
RELAXATION
1.
Other…
6.
Add row
or
add "Other"
Columns
1
2
3
4
5
Other…
Add column
or
add "Other"
…
Answer key
(0 points)
Require a response in each row
Required
Required
Loading...
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RED HULU
*
Question
RED HULU
*
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Description
Loading image…
Caption
1
2
3
4
5
ENERGY
MOOD
RELIEF
STIMULATION
RELAXATION
Rows
1.
ENERGY
2.
MOOD
3.
RELIEF
4.
STIMULATION
5.
RELAXATION
1.
Other…
6.
Add row
or
add "Other"
Columns
1
2
3
4
5
Other…
Add column
or
add "Other"
…
Answer key
(0 points)
Require a response in each row
Required
Required
Loading...
Loading…
GREEN HULU
*
Question
GREEN HULU
*
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Description
Loading image…
Caption
1
2
3
4
5
ENERGY
MOOD
RELIEF
STIMULATION
RELAXATION