Email Address
First Name
Last Name
Mailing Address
City
State
Zip
Restaurant Visited
Choose one...
Doc Holliday's - Lancaster
Doc Holliday's - New Cumberland
Gibraltar
Barny's
Lancaster Brewing Company - Lancaster
Lancaster Brewing Company - Harrisburg
Date Visited
mm/dd/yyyy
Number in Party
Lunch or Dinner
Choose one...
Lunch
Dinner
Server Name
How often do you dine with us?
Choose one...
First Time
Once in a while
Regularly
Which entrees did you select?
How did you hear about us?
Please rate the items below. 5 = Superior, 1 = Poor
Were you treated in a friendly manner?
Choose one...
5
4
3
2
1
Food Quality
Choose one...
5
4
3
2
1
Food Presentation
Choose one...
5
4
3
2
1
Service
Choose one...
5
4
3
2
1
Promptness
Choose one...
5
4
3
2
1
Food and service compared to pricing
Choose one...
5
4
3
2
1
Overall, how do you feel about your visit?
Choose one...
5
4
3
2
1
Additional comments
Close Window