Restaurant Survey
Date Visited:
Dine In/Take Out:
Dine In
Take Out
Food Quality:
Excellent
Good
Average
Dissatisfied
Overall Service:
Excellent
Good
Average
Dissatisfied
Cleanliness:
Excellent
Good
Average
Dissatisfied
Order Accuracy:
Excellent
Good
Average
Dissatisfied
Speed of Service:
Excellent
Good
Average
Dissatisfied
Value:
Excellent
Good
Average
Dissatisfied
Overall Experience:
Excellent
Good
Average
Dissatisfied
Comments, Questions or Suggestions:
Name:
Age:
Age
under 13
13-17
18-24
25-34
35-44
45-54
over 54
Email: