Juanita's Louetta - Comment Card

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 Twice a month Once a week Five or more times a month

How did you hear about us? *

Stumbled upon Friend / Family / Colleague Online Search Facebook Yelp / TripAdvisor

Name of Server? *

Any comments, questions or suggestions? (Optional)

0/250

Date of your visit *

- Month - Day Year

Your name *

First Name Last Name

Birthday (mm/dd)

Anniversary (mm/dd)

Phone Number

- Area Code Phone Number

E-mail *

Would you like to be on our email list? *

Yes No

Check the box to confirm you are not a robot *