The questionnaire presented here was designed to collect linguistic data in Gozitan dialects, which are classified as rural dialects of the Maltese language. It consists of three parts: lexical, phonological and morphological. Since a particular feature of the Gozitan dialects are pausal forms involving diphthongisation of etymologically long vowels ( *ī and *ū), attention is directed towards contextual as well as pausal data acquisition. In the morphological part, the issues concerning verbs are mainly expanded, while in the phonological part, those concerning the realisation of vowels. With minor modifications, the questionnaire can also be used to conduct field research on dialects of the island of Malta.