Was this your first Lion's Choice visit?
Yes
No
If yes, will you visit again?
Yes
No
If no, how often do you visit
As much as possible
Once a week
Once a month
Overall:
*
Excellent
Satisfactory
Poor
Food:
*
Excellent
Satisfactory
Poor
Service:
*
Excellent
Satisfactory
Poor
What are we doing well and how can we improve?
*
First Name
Last Name
Address
Street
City
State
Zip
Email Address
Restaurant Location
Time of Day
:
pm
am
ex. 5:00 p.m.
Date of visit
/
/
2009
2010
2011
2012
day / month / year
Would you like someone to contact you about your visit?
Yes
No
