In order to do this yourself, you'll need some sort of server-
side program to process the form, such as PHP. There are
other aspects as well, such as people taking it more than once
on a particular PC. For better control, and since you might
not know how to program in PHP, use a free online service to
host your survey (link below for one of several to choose
from).

Those online services will allow you to control how many times
a particular IP address can access the survey, and give you
nice statistical results, and emails.

-max-

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