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Name: *
Address:
City:
State:
Zip:
Email Address: *
Phone(Day):

. Was this your first visit to this restaurant?
Yes
No

3. How would you rate the quality of the food?
5 (Excellent)
4 (Good)
 3 (Mediocre)
2 (Poor)
1 (Unacceptable)
4. How would you rate the variety of the menu?
5 (Excellent)
4 (Good)
3 (Mediocre)
2 (Poor)
1 (Unacceptable)
5. How would you rate the value for the money?
5 (Excellent)
4 (Good)
3 (Mediocre)
2 (Poor)
1 (Unacceptable)
6. Did we meet or exceed your expectations?
Exceed
Meet
Did not meet
7. Is there anything that the restaurant could have done to exceed your expectations?
8. How satisfied overall were you with this visit to this restaurant?
5 (Excellent)
4 (Good)
3 (Mediocre)
2 (Poor)
1 (Unacceptable)
9. Would you recommend this restaurant to your friends?
Yes
No