Restaurant Evaluation Survey
Please let us know how was the food and service.
SATISFACTION SURVEY
Day Visited:
Month Day Year
Dine In / Take Out:
Dine In Take Out
Food Quality:
Excellent Good Average Dissatisfied
Overall Service Quality:
Excellent Good Average Dissatisfied
Cleanliness:
Excellent Good Average Dissatisfied
Order Accuracy:
Excellent Good Average Dissatisfied
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:
Excellent Good Average Dissatisfied
Any comments, questions or suggestions?
PERSONAL INFORMATION
Name
First Name Last Name
Age
Email
example@example.com
Phone Number
Area Code Phone Number
Should be Empty: