Customer Satisfaction Survey

Your Name (required)

Number In Party

Date of Visit

Time of Visit

Your Server

Your Order Number

Your Email (required)

Phone Number








Did you have a reservation:

Were you greeted promptly:

Were you seated promptly:

Were evening specials presented:

Please rate the following 1 to 5 (5 being the best rating)

Overall Server Knowledge:

Overall Food Quality:

Overall Atmosphere:

Overall Quality of Service:

Overall Experience:

How did you hear about Emily's


 Chamber/Chamber Publications Chamber/Chamber Publications


 Internet (list website) Internet (list website)


 Hotel/BB/etc (please name) Hotel/BB/etc (please name)


 Word of Mouth Word of Mouth


Other:


Would you consider buying soups or other food products on-line?


Would you like yo join our mailing list? (input your email list):

Physical name & address for Gift Certificate Mailing If Needed - Will never be used for anything else.
Name:
Street PO Box:
City State Zip:

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