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Questions marked with a * are required Exit Survey
 
 
* Name
   
 
 
 
* How many faxes do you receive per week?
 
0-1
 
2-5
 
6-10
 
11+
 
 
 
* Are the faxes you receive sensitive in nature?
 
Yes
 
No
 
 
 
* Can other technology substitute your need to receive a fax (i.e. email or web submission?
 
Yes
 
No
 
 
 
If yes, please describe how you can or would like to receive this information.
   
 
 
 
If no, why do you need direct fax?