EVALUATION FORM
PLEASE SHARE YOUR EXPERIENCE WITH US
DATE OF VISIT:
*
/
Month
/
Day
Year
Date Picker Icon
DINE IN / TAKE OUT:
*
Dine in
Take out
SERVER / HOST:
FOOD QUALITY:
*
Rows
EXCELLENT
GOOD
FAIR
POOR
TASTE
PORTION SIZE
FRESHNESS
SERVICE:
*
Rows
EXCELLENT
GOOD
FAIR
POOR
SPEED OF SERVICE
FRIENDLINESS
ATTENTIVENESS
KNOWLEDGE OF MENUS
CLEANLINESS AND AMBIANCE:
*
Rows
EXCELLENT
GOOD
FAIR
POOR
CLEANLINESS
ATMOSPHERE
SEATING COMFORTNESS
AMBIENT NOISE LEVEL
VALUE FOR MONEY:
*
Rows
EXCELLENT
GOOD
FAIR
POOR
MENU PRICE
MENU PORTION
MENU OPTIONS:
*
Rows
EXCELLENT
GOOD
FAIR
POOR
VARIETY OF OPTIONS
OPTIONS FOR DIETARY RESTRICTIONS
OVERALL EXPERIENCE:
*
Rows
VERY LIKELY
LIKELY
UNLIKELY
HOW LIKELY ARE YOU TO VISIT AGAIN
HOW LIKELY ARE YOU TO RECOMMEND US TO OTHERS
COMMENTS / SUGGESTIONS:
PLEASE LET US KNOW WHAT YOU THINK:
How much are you willing to spend on a meal?
*
Would you like to try $29.95 for "All You Can Eat", if we offer such option?
*
Do you like to be seated at the Hibachi Grill?
*
If so, how many times do you think you would try it in a month?
*
Which of the following dishes would you like us to add to our new menu?
*
Ramen
Pad Thai
Curry
Beef Gyudon
Other (please specify)
Name:
*
*please provide name that matches your ID
Age:
*optional
Email:
*
*please provide a valid email
Submit
Should be Empty: