| DATE YOU VISITED THE RESTAURANT: |
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| HOW MANY PERSONS WERE IN YOUR PARTY?: |
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| MEAL PERIOD (Breakfast, Lunch or Dinner): |
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| WERE YOU GREETED UPON ARRIVAL?: |
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| WAS YOUR SERVER COURTEOUS AND ATTENTIVE?: |
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| DID YOUR DRINKS ARRIVE PROMPTLY?: |
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| WAS YOUR DRINK TO YOUR SATISFACTION?: |
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| DID YOUR SERVER EXPLAIN THAT THE DISHES ARE PREPARED TO ORDER?: |
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| DID YOUR MEAL ARRIVE TIMELY?: |
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| WAS YOUR MEAL TO YOUR SATISFACTION?: |
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| WAS THE AMBIANCE OF THE RESTAURANT ENJOYABLE?: |
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| COMMENTS: |
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| |
