* 1. What is your first name?

* 2. What is your last name?

* 3. Address

* 4. Phone number

* 5. Email

* 6. How would you rate your TV reception before the switch from analog to digital out of 10?

* 7. How would you rate your TV reception after the switch from analog to digital out of 10?

* 8. Do specific weather conditions affect your reception? If yes give details.

* 9. Has a technician visited your house to provide advice on how to improve your service? If yes, did your TV reception improve?

* 10. Have you had to purchase an outside aerial to receive a digital TV signal? If yes, please give details of improvement.

* 11. If your reception only allows for certain channels to properly function, which channels are you able to tune in to?

* 12. If you have no access to reception, what entertainment and news sources have you replaced TV with?

* 13. Would you like to provide further information about your digital television reception?

* 14. Please advise if you would like to be contacted about the information provided.

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