Hostess: Courtesy and friendliness of staff
*
1
2
3
4
5
Poor
Excellent
Hostess: Accuracy of wait time
*
1
2
3
4
5
Poor
Excellent
Hostess: Attentiveness
*
1
2
3
4
5
Poor
Excellent
Server: Speed of service
*
1
2
3
4
5
Poor
Excellent
Server: Attentiveness
*
1
2
3
4
5
Poor
Excellent
Server: Product knowledge
*
1
2
3
4
5
Poor
Excellent
Food Quality
*
1
2
3
4
5
Poor
Excellent
Menu Variety
*
1
2
3
4
5
Poor
Excellent
Hot food served hot?
*
1
2
3
4
5
Poor
Excellent
Cold items served cold?
*
1
2
3
4
5
Poor
Excellent
Presentation of food
*
1
2
3
4
5
Poor
Excellent
Atmosphere
*
1
2
3
4
5
Poor
Excellent
Cleanliness
*
1
2
3
4
5
Poor
Excellent
Overall experience
*
1
2
3
4
5
Poor
Excellent
Your order was for:
*
Dine In
Take Out
Online Order
You visited us for:
*
Breakfast
Lunch
Dinner
Manager visited your table?
*
Yes
No
I ordered take out / online
I...
Live within 3 miles
Live within 3 - 5 miles
Live more than 5 miles
Work within 3 miles
Work within 3-5 miles
Work more than 5 miles
How often do you visit us?
First time
Once a month
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How did you hear about us?
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Friend / Family / Colleague
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Name of Server?
*
Any comments, questions or suggestions? (Optional)
0/250
Date of your visit
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-
Month
-
Day
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Your name
*
First Name
Last Name
Birthday (mm/dd)
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