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RESTAURANT INFORMATION

Restaurant Name *

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Restaurant Location *

State

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Date and Time of visit *

Date

Time

Day of Visit *

Approximate Length of Visit *

DISCREET DINER INFORMATION

Discreet Diner Name *

Address *

Address Line 1

City

State

Zip Code

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Phone *

Email *

Reimbursement Type

Venmo
PayPal
Mail Check

Insert user name *

OVERALL EXPERIENCE

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If you only could give ONE simple score, how would you rate your OVERALL EXPERIENCE at this specific establishment during this specific visit? *

Add Additional Comments

Additional Comments *

Based on your visit, would you RECOMMEND this restaurant to others? *

How likely are you to REVISIT this restaurant in the future? *

What is your opinion on the overall PRICE to the VALUE you received?

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Additional Comments *

Do you have any overall comments or suggestions for improvement?

BRAND & MARKET MESSAGING

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If you only could give ONE simple score, what was your OVERALL perception of the holistic BRAND (look, feel, culture, presentation)? *

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Additional Comments *

How did you perceive the actual PHYSICAL BRANDING (all use of logos, fonts, color scheme, etc.)? *

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Additional Comments *

Did you use a LOYALTY Program?

Yes
No

How was your experience?

Additional Comments *

Were you offered or asked about a LOYALTY Program? *

Yes
No

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Did you use a Mobile App? *

Yes
No

How was your experience?

Additional Comments *

Did the specific location have any easily findable or presented SOCIAL MEDIA presence? *

Yes
No
Couldn’t locate it

What was your perception of it?

Additional Comments *

Did this specific location have a FACEBOOK presence? *

Yes
No
Couldn’t locate it

What was your perception of it?

Additional Comments *

Did this specific location have a YELP Presence? *

Yes
No
Couldn’t locate it

What was your perception of it?

Additional Comments *

Did this specific location have a have a GOOGLE BUSINESS presence *

Yes
No
Couldn’t locate it

What was your perception of it?

Additional Comments *

Did this specific location have a WEBSITE *

Yes
No
Couldn’t locate it

What was your perception of it?

Additional Comments *

Did this specific location have an INSTAGRAM presence *

Yes
No
Couldn’t locate it

What was your perception of it?

Additional Comments *

EXTERNAL BUILDING

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If you only could give ONE simple score, what was your OVERALL Experience of the EXTERNAL portion the restaurant? *

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Additional Comments *

What was your opinion of the LOCATION and the SURROUNDINGS? *

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Additional Comments *

How easy was ACCESSIBILITY to the location? *

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Additional Comments *

How did you perceive the SIGNAGE? *

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Additional Comments *

How did you perceive the general EXTERIOR Appearance? *

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Additional Comments *

How was the general CLEANLINESS of the location? *

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Additional Comments *

Was the location easy to LOCATE? *

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Additional Comments *

What was your experience in the ease of PARKING? *

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Additional Comments *

INSIDE THE LOCATION

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If you only could give ONE simple score, what is your OVERALL Experience of the INTERNAL portion of the restaurant? *

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Additional Comments *

What was your perception of the WAITING / ENTRY Area *

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Additional Comments *

What was your opinion of the general ATMOSPHERE of the entire establishment? *

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Additional Comments *

What was your opinion of the LIGHTING, and was it appropriate for the theme? *

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Additional Comments *

How comfortable in general was the physical ENVIRONMENT? *

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Additional Comments *

How did you perceive the TABLE SETTING and CLEANLINESS of your specific seated location? *

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Additional Comments *

How did you perceive the INTERIOR DESIGN and DÉCOR, and was it appropriate for the theme? *

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Additional Comments *

What was you opinion of the overall NOISE LEVEL, and was it appropriate for the theme and occupancy? *

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Additional Comments *

What was your opinion of the MUSIC choice, and was it appropriate for the theme? *

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Additional Comments *

Were the WOMEN’S RESTROOMS clean and orderly? *

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Additional Comments *

Were the MEN’S RESTROOMS clean and orderly? *

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Additional Comments *

How did you perceive the LIVE ENTERTAINMENT, and was it appropriate for the theme and patrons? (if applicable) *

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Additional Comments *

STAFF / SERVICE

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If you only could give ONE simple score, how would you rate your OVERALL experience with the STAFF and SERVICE level? *

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Additional Comments *

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How smoothly did the GREETING and SEATING process go? *

Greeters Name

Additional Comments *

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How was the Server’s general FRIENDLINESS and DEMEANOR toward you? *

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Additional Comments *

How was the Server’s general HYGIENE and APPEARANCE? *

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Additional Comments *

How was the Server’s general ATTENTIVENESS and INTERACTION with you? *

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Additional Comments *

How was the Server’s MENU KNOWLEDGE? *

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Additional Comments *

Did the Server use any UPSELLING Techniques? *

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Additional Comments *

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Did you have any Interaction with MANAGEMENT or other staff? *

Yes
No

How you’re your experience?

Names and/or Position

Additional Comments *

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How was the SPEED and EFFICIENCY of the serving process? *

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Additional Comments

How smoothly did the CHECK and PAYMENT process go? *

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Additional Comments *

How was the ACCURACY of the entire order? *

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Additional Comments *

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Did the server remember the proper PLACEMENT of each order? *

Yes
No

How was your experience?

Additional Comments *

Did you experience any SPECIAL REQUESTS handling? *

Yes
No

How was your experience?

Additional Comments *

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How did you experience the TIMELINESS of the food’s serving *

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Additional Comments *

FOOD

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If you only could give ONE simple score, how would you rate the OVERALL FOOD you experienced? *

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Additional Comments *

How did you perceive the MENU PRESENTATION and SELECTION? *

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Additional Comments *

How did you perceive the BEVERAGE PRESENTATION and SELECTION? *

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Additional Comments *

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Did your server ask about any DIETARY ACCOMMODATIONS? *

Yes
No

How was your experience?

Additional Comments

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How did you perceive the food’s PRESENTATION and PLATING experience *

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Additional Comments *

How did you experience the overall TASTE of the food? *

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Additional Comments *

How was the Food TEMPERATURE & VENTILATION? *

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Additional Comments

How did you perceive the FOOD QUALITY? *

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Additional Comments *

How did you perceive the FOOD PORTIONS *

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Additional Comments *

GENERAL / MISCELANEOUS ADDITIONAL ITEMS

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Did you utilize an ONLINE ORDERING or RESERVATION process? *

Yes
No

How was your experience?

Additional Comments *

Were there any ISSUES or COMPLAINTS *

Yes
No

How was your experience?

Additional Comments *

Were there any unique SAFETY and/or SECURITY issues? *

Yes
No

How was your experience?

Additional Comments *

Do you have any general additional comments, suggestions or questions?

Would you like us to contact you about your experience?

Yes
No

Would you be willing to write a positive sentence or two that we could use in our marketing?

Yes
No

Review *

Would you be willing to fill out any POSITIVE online review, for additional potential compensation (YELP / Google / Open Table)?

Yes
No

File Upload *

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SUBMISSION OF PHOTOS

RECEIPT

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OVERALL EXPERIENCE / FOOD / IMPORTANT ITEMS WE SHOULD SEE

Click or drag files to this area to upload. You can upload up to 5 files.

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