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Select Restaurant
Kiki B's
A Movable Feast
Date & Time of Visit
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
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12
13
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15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2008
2007
7:00 AM
8:00 AM
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
5:00 PM
6:00 PM
7:00 PM
8:00 PM
9:00 PM
10:00 PM
Was this
your first visit?
Yes
No
How would you rate
the service?
5 (Excellent)
4 (Good)
3 (Mediocre)
2 (Poor)
1 (Unacceptable)
How would you
rate the quality
of the food?
5 (Excellent)
4 (Good)
3 (Mediocre)
2 (Poor)
1 (Unacceptable)
How would you
rate the variety
of the menu?
5 (Excellent)
4 (Good)
3 (Mediocre)
2 (Poor)
1 (Unacceptable)
How would you
rate the value
for the money?
5 (Excellent)
4 (Good)
3 (Mediocre)
2 (Poor)
1 (Unacceptable)
Did we meet or exceed
your expectations?
Exceed
Meet
Did not meet
Is there anything that the restaurant could have/should have done
to exceed your expectations?
How satisfied overall
were you with this
restaurant visit?
5 (Excellent)
4 (Good)
3 (Mediocre)
2 (Poor)
1 (Unacceptable)
Would you recommend
this restaurant?
Yes
No