A Gift Certificate for Your Thoughts....

Please take a moment to fill out this feedback form. In doing so, your response will be entered in our monthly drawing giveaway. We will be randomly selecting one form a month to give away a $25.00 gift certificate. All you have to do is tell us about your dining experience!

Your Name:
Your Phone:
Your Email:
Server Name:
Day of Visit	Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Date	Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Lunch			Dinner	Brunch

1. Rate your server...	Excellent	Good	Fair	Poor
Courteous & Pleasant
Attentive
Time to be served
Did Your Server Greet You Within 2 Minutes With a Smile?			Yes No
Did Your Server Check Back After Your Food Was Delivered?			Yes No
Was Your Server Knowledgeable About the Menu?			Yes No
Did Your Server Tell You About the Specials?			Yes No
Did Your Server Offer You Dessert and Coffee?			Yes No

2. How was the...	Excellent	Good	Fair	Poor
Menu Variety
Food Value
Beverage Value
Quality of Food
Quality of Beverage
Restaurant Atmosphere
Were You Greeted With a Smile at the Front Desk?			Yes No
Were You Thanked and Welcomed Back?			Yes No
Your Suggestions....Please!
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