Restaurant Monthly Special Voting Form
Vote for your favorite monthly special, rate our dishes, and help us choose future specials!
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
How often do you dine at our restaurant?
*
Please Select
First time
Once a month
2-3 times a month
Weekly
More than once a week
Which age group do you belong to?
Please Select
Under 18
18-24
25-34
35-44
45-54
55+
Vote for Your Favorite Monthly Special
*
Grilled Salmon with Lemon Butter
Stuffed Portobello Mushrooms
Spicy Cajun Chicken Pasta
Classic Beef Wellington
Other (please specify)
Please rate the following monthly specials you have tried:
Rows
Excellent
Good
Average
Poor
Grilled Salmon with Lemon Butter
1
2
3
4
Stuffed Portobello Mushrooms
5
6
7
8
Spicy Cajun Chicken Pasta
9
10
11
12
Classic Beef Wellington
13
14
15
16
How would you rate your overall dining experience this month?
*
1
2
3
4
5
What influenced your vote for the monthly special?
*
Taste
Presentation
Ingredients
Value for money
Recommendation from staff
Other
Please suggest a new dish or special you would like to see next month:
Any additional comments or feedback?
Submit Vote
Should be Empty: