Form

your invoice number*
Full Name*
First Name Last Name
E-mail*
Phone Number*
- Area Code Phone Number

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Were you in for Lunch or Dinner*
When did you visit*
- Month - Day Year
at
/ Hour Minutes
Server's Name*
Number of persons in your party*
Which other restaurants do you frequent*
In General how do we compare to other restaurants you frequent*

not as good just as good better

Our Staff
Were you greeted and welcomed in a friendly and personable manner*

yes no
Were you seated efficiently and courteously*

yes no
Was our staff friendly and personable*

yes no
Were you thanked by our hostess or other staff member upon your departure*

yes no
Please rate our staff*
Please leave any comments about our staff*

Our Food
How would you rate our food overall*
please list what you ordered (where applicable)
Appetizer
Rating
Salad
Rating
Pasta
Rating
Meat/Fish/Other
Rating
Dessert
Rating
How is our price to value ratio?*

the food was not worth the price the food was worth what we paid
Was the variety of menu options sufficient*

yes no
Please leave any comments and observations about our food*

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