Receipt Date

MM

DD

YYYY

Receipt Time

Hour

Minute

Second

AM PM

How often do you dine at Pasta Grill? *

First visit

Once a week

Twice a month

Once a month

Only on special occasions

Were you greeted upon arrival and when leaving the restaurant? *

Yes

No

How would you rate your entree? *

Excellent

Good

Average

Below Average

Poor

How would you rate your service? *

Excellent

Good

Average

Below Average

Poor

How would you rate your overall experience? *

Excellent

Good

Average

Below Average

Poor