Provider Contract Food Service

How we doin'!

Your opinion is the only one that counts!

Location

other location:

Date of Service

No. in Party

Meal Occasion

Breakfast Lunch Dinner First Visit Repeat Visit

How Did You Hear About Us?

Drive By Friends/Family Newspaper Other

A. Please Rate The Food Ordered Today

Very Good to Excellent		Average or Below
1. Breakfast
2. Lunch
3. Dinner
4. Daily special
5. Sandwich
6. Pizza
7. Salads
8. Coffee drinks
9. Smoothie bar
10. Grab-n-go
11. Sushi items
12. Retail selection
13. Soups
14. Desserts

B. Please Rate your food on the following:

Very Good to Excellent		Average or Below
15. Appearance
16. Taste / Flavor
17. Temperature
18. Portion size

C. Please comment on our performance:

Very Good to Excellent		Average or Below
19. Greetings / Thanks
20. Staff friendliness
21. Staff appearance
22. Facility Cleanliness
23. Breakfast value
24. Lunch value
25. Dinner value
26. Overall value

D. Please comment on speed of service:

Very Good to Excellent		Average or Below
27. Time in line
28. At order counter
29. At cash register
30. For food delivery

Remember, your opinion is the only one that counts so please feel free to help us make our restaurant/café your favorite place to eat. Please share your thoughts and ideas with us.

E. What did you like best about your dining Experience?

F. What would you like to see changed?

G. What would you like to see added to our menu?

H. Please describe our service?

I. Other comments are welcome!

Name and Address (Optional)

Name

Street

City

State

Zip

This information will be handled confidentially. We may use it
from time to time to send special offers or information to you directly.