Austin's American Grill (HARMONY) Guest Feedback

Question Title

* 1. What was the date of your visit?

Date

Date

Question Title

* 2. How likely are you to recommend Austin's on Harmony?

Extremely likely

Very likely

Somewhat likely

Not so likely

Not at all likely

Question Title

* 3. Which meal did you eat?

Question Title

* 4. Which menu items did you order today?

Question Title

* 5. Please rate the following:

	Very Poor	Poor	Okay	Good	Excellent
Timeliness	Timeliness Very Poor	Timeliness Poor	Timeliness Okay	Timeliness Good	Timeliness Excellent
Taste	Taste Very Poor	Taste Poor	Taste Okay	Taste Good	Taste Excellent
Service	Service Very Poor	Service Poor	Service Okay	Service Good	Service Excellent
Overall Value	Overall Value Very Poor	Overall Value Poor	Overall Value Okay	Overall Value Good	Overall Value Excellent
Atmosphere	Atmosphere Very Poor	Atmosphere Poor	Atmosphere Okay	Atmosphere Good	Atmosphere Excellent
Cleanliness	Cleanliness Very Poor	Cleanliness Poor	Cleanliness Okay	Cleanliness Good	Cleanliness Excellent

Question Title

* 6. Did a manager visit your table?

Yes

No

Question Title

* 7. Comments:

Question Title

* 8. Contact Info

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 9. Would you like to receive our enewsletter?

Yes

No