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Leave us with some of your Feedback!
Fill out the survey below
Contact Information
Name
Phone
Email
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Contact Address
Street
City
State/Province
Zip/Postal Code
Visit Information
Date Visited:
‹
January 2021
›
Su
Mo
Tu
We
Th
Fr
Sa
27
28
29
30
31
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1
2
3
4
5
6
Approximate Time of Visit:
Did you visit with:
Choose an option
Your Wife
Girlfriend
Your Husband
Boyfriend
Not so good friend after all
By yourself looking for a new friend
With your parents
With your children
Want us to cover for ya
Other
Are you here because of a promotional program?
Choose an option
Yes
No
If so, which one?
Choose an option
Birthday Club
Other
Are you a returning customer from a specific promotional program?
Rating System
How would you Rate our Service?
Choose an option
5 (Highest)
4
3
2
1 (Lowest)
How would you Rate Our Food?
Choose an option
5 (Highest)
4
3
2
1 (Lowest)
How did you like our Atmosphere?
Choose an option
5 (Highest)
4
3
2
1 (Lowest)
How would you Rate Our Establishment Overall?
Choose an option
5 (Highest)
4
3
2
1 (Lowest)
Additional Information
How often are you a regular customer at Brady's Tavern?
Choose an option
2+ Weekly
1-4x Monthly
1-6x a Year
1st Time!
When is our business birthday with you? (when did you become a customer?)
‹
January 2021
›
Su
Mo
Tu
We
Th
Fr
Sa
27
28
29
30
31
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1
2
3
4
5
6
Additional Information
Notes:
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