Store location:
Date and time of visit:
Name:
Email:

	Excellent	Good	Average	Fair	Poor
Cleanliness
Service Speed
Friendliness
Food Quality
Value

How often do you eat here? Approximately:
This is my first visit
Rarely
Once a month
Twice a month
Once a week
More than once a week

Why do you eat here (please pick two):
Convenience/Location
Price/Value
Freshness/Quality
Vegetarian/Health options
Speed
Atmosphere/Friendliness of staff

Comments: (optional)