Location Visited: 

Date Visited: 
Time of day: 
Who was your server or bartender today?  
Were you greeted promptly?   Yes   No

(For the next two questions use a scale of 1-10, with 10 being the best)
How would you rate the level of service today?  
How would you rate the level of cleanliness of the store?  

Overall, how satisfied were you with the quality of your meal today?
   Very Satisfied    Satisfied   Neither
   Dissatisfied    Very Dissatisfied  
What did you have today? 
 
Did a manager visit you today?   Yes   No
If so, which manager spoke with you?  

Name, Zip Code, Email
Name:  (optional)
Zip Code:  
Email:    

Additional Comments or Suggestions:

*All information submitted will be kept confidential