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Comments

Date of Visit:
Time of Visit:	AM PM
Name:
Phone:
Email Address:

Did you come with:	Family Spouse Friends Business Asscociates Date Alone
How often do you come to Butcher Block Restaurant:	Daily Weekly Monthly Occasionally
What did your party order?

Was your entree served in a timely manner? Yes No

What items did you like the best?

How would you rate our food on:

	Exc	Very Good	Good	Fair	Poor
Appearance:
Taste:
Temperature:
Portion Size:
Price:

How would you rate our service on:

	Exc	Very Good	Good	Fair	Poor
Promptness:
Friendliness:
Attentiveness:
Accuracy:

Server:

Overall, how would you rate your experience?
Would you come back?	Yes No
Other Comments: