Survey

Date of visit:   i.e., 7 June 2008

Time of visit:
i.e., 3pm

Guests in party: people


Please answer the following questions on a scale of 1 to 5.
1 is poor, 3 is average, and 5 is superb.

  1 2 3 4 5  Comments
 Food  
 Service  
 Atmosphere  
 Wine List  
 Overall  


Do you plan to join us again in the future?
yes no

If not, please share your reasons(s) with us:

How could we have improved your experience?


How did you find us?

A search engine
Word of mouth
Link from a web site
Print media or advertising
Web advertising


Optional: If you would like us to respond to your comments please provide the following information.

Name
Phone Number
Email Address

Human image test
To verify that you are a human, please enter the above text in the box below.


Once you have completed the survey click the submit button to send it to us.


 

 

 

 

 

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