Customer Feed Back Form

Customer Feedback:

Date
What was the occasion?
Lunch Dinner Drinks
Who was with you today?
Just me Family Friends Colleagues
How often do you visit per month? 1 2 3 4
Were the portions large enough? Excellent Good Fair Poor
How was the quality of your food? Excellent Good Fair Poor
Was your server friendly/timely? Excellent Good Fair Poor
Did staff make you feel welcome? Excellent Good Fair Poor
Were our restrooms clean/stocked? Excellent Good Fair Poor
Did a manager visit your table? Yes No
Will you be returning? Definitely Probably Not likely
How did you hear about us? Radio TV Direct Mail Newspaper
Friend Billboard Other
Additional Comments
(Optional)
First Name
Last Name
Address
City State Zip
Work Phone Home Phone Email