Was this your first Lion's Choice visit? Yes No If yes, will you visit again? Yes No If no, how often do you visit As much as possible Once a week Once a month Overall:* Excellent Satisfactory Poor Food:* Excellent Satisfactory Poor Service:* Excellent Satisfactory Poor What are we doing well and how can we improve?* First Name Last Name Phone Number Address Street City State Zip Email Address Restaurant Location Time of Day : pm am ex. 5:00 p.m. Date of visit / / 2007 2008 2009 2010 day / month / year Would you like someone to contact you about your visit? Yes No