Restaurant Evaluation Survey
Date of Visit
Dine In / Take out
Dine In
Take Out
Food Quality
Excellent
Good
Average
Not Satisfied
Customer Service
Excellent
Good
Average
Not Satisfied
Cleanliness
Excellent
Good
Average
Not Satisfied
Overall Experience
Excellent
Good
Average
Not Satisfied
Comments and Suggestions
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Form service by Formlets.com
January
February
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April
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June
July
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September
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November
December
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31
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31
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