We Want Your Feedback! Date of Visit MM DD YYYY How often do you visit? * First time Once per month Twice per month Four times per month + Survey 1 = Poor | 2 = Fair | 3 = Average | 4 = Good | 5 = Excellent Overall Experience * 1 2 3 4 5 Food Quality * 1 2 3 4 5 Service * 1 2 3 4 5 Atmosphere * 1 2 3 4 5 Would you like a manager to contact you? Yes No Email Phone (###) ### #### Additional Comments We appreciate your feedback. If you selected to be contacted, we will be in touch soon!
