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Customer Satisfaction Survey
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* Indicates required question
Name:
*
Your answer
Email Address :
*
Your answer
Phone Number:
*
Your answer
Date Of Visit:
*
MM
/
DD
/
YYYY
Time Of Visit:
*
Time
:
AM
PM
Dine In Or Take Out?
*
Dine In
Take Out
Age:
*
Your answer
Rate the food quality:
1
2
3
4
5
Clear selection
Rate the service by our staff:
*
1
2
3
4
5
Rate the cleanliness of our business:
*
1
2
3
4
5
Rate the order accuracy of your visit:
*
1
2
3
4
5
Rate the speed of service:
*
1
2
3
4
5
Rate the overall value of your visit:
*
1
2
3
4
5
Rate your overall experience:
*
1
2
3
4
5
Do you consent to receive emails and/or text messages regarding specials and events we have at the Purgatory?
*
YES
NO
Any additional comments, compliments, or concerns?
Your answer
Submit
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