Restaurant Evaluation Form

Restaurant Evaluation Survey
Please let us know how was the food and service.
SATISFACTION SURVEY
Day Visited:
MonthDayYear
Dine In / Take Out:
Dine InTake Out
Food Quality:
ExcellentGoodAverageDissatisfied
Overall Service Quality:
ExcellentGoodAverageDissatisfied
Cleanliness:
ExcellentGoodAverageDissatisfied
Order Accuracy:
ExcellentGoodAverageDissatisfied
Speed of Service:

1 2 3 4 5
1 is Very Slow, 5 is Very Fast
Value:

1 2 3 4 5
1 is Very Expensive, 5 is Very Cheap
Overall Experience:
ExcellentGoodAverageDissatisfied
Any comments, questions or suggestions?
PERSONAL INFORMATION
Name
First NameLast Name
Age
Email
example@example.com
Phone Number
Area CodePhone Number
Should be Empty: