Order Number Your Name * Server's Name Check Number on Receipt * Email * Cell Phone Would you like to be contacted by a manager * Yes No Did a manager visit your table Yes No Is this your first visit Yes No Will you recommend us Yes No Date & time of visit * How can we improve Host/Hostess Seating Great Good Poor Speed of Kitchen Great Good Poor Waiter/Waitress Great Good Poor Atmosphere Great Good Poor Food Quality Great Good Poor Restaurant Cleanliness Great Good Poor Overall Value Great Good Poor terms I have read and agreed to the Terms of Service
