Scramblers Share with Marie

Location Visited*

Did you Dine-In or Carry-out?*

Dine-InCarry-Out

Date*

MonthDayYear

Time

:HourMinutesAM/PM Option

If known, what was your server's name?

Food Quality

	Yes	Somewhat	No	N/A
Was your food prepared the way you expected?
Was your food tasty and flavorful?
Was your hot food served hot as you expected?
Was your meal a good value for your money?

Service Quality

	Yes	Somewhat	No	N/A
Was your server friendly and knowledgeable?
Was your server attentive and available?
Was your food order correct and complete?

Restaurant Quality

	Yes	Somewhat	No	N/A
Was our staff groomed and dressed professionally?
Was your table clean and comfortable for you?
Were our bathroom facilities well stocked and clean?
Overall, was our restaurant comfortable and inviting?

How likely is it that you would recommend Scramblers to a friend or colleague?

Please tell us how we can improve our service, food or restaurant.

Guest Contact Information

Name*

First NameLast Name

E-mail*

Phone Number*

Mailing Address

Street Address

Street Address Line 2

CityState

Zip Code