Day Of Visit:		Time:		am	pm
Name:
Phone:
Email:

Did you come with:	Family	Friend	Spouse
	Alone	Date	Bus. Associate

How did you hear about us?
Do you visit Host's other locations?	Yes No
How often do you come to The Host?	/month
What did your party order?
Was your food served in a timely matter:	Yes No
What item(s) did you like best?

How would you rate our food on:	Exc.	V.Good	Good	Fair	Poor
Appearance
Taste
Temperature
Portion Size
Price
How would you rate our service on:	Exc.	V.Good	Good	Fair	Poor
Promptness
Friendliness
Attentiveness
Accuracy

Server Name:
Would you come back?	Yes No
Other comments and suggestions: