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Text in this example:
Please help us learn
what we're doing right and
what we need more work
on by filling out this card How many in your party? Date Dine in Take out Breakfast Lunch Dinner The name of your server: What did you order? Quality of food: Excellent Good Fair Poor Portion size: Excellent Good Fair Poor Ease of Ordering: Excellent Good Fair Poor Service: Excellent Good Fair Poor Cleanliness: Excellent Good Fair Poor Overall Value: Excellent Good Fair Poor Comments? Age? Under 18 19-34 35-54 55+ Male Female How did you learn about us? Newspaper TV Radio Friend Other: Restaurant Survey