Your Experience
Contact Information
Name:
Street:
City:
State/Province:
Zip/Postal Code:
Phone:
Email:

Time & Date of Visit
Date Visited:
Approximate Time of Visit:

Requested Information
What brings you to the Cocoa House & how did you hear about us?
How often do you eat out a month & where else do you go?
What would you like to see on the menu?
I Visit The Cocoa House:

Rating System
Did our employees warmly greet you?
Did your food look appetizing?
Was your food served at the right temperature?
How was the quality of your food?
Were our portions just right?
Did our prices please you?
Was our server delightfully charming & helpful?
Did our server suggest our wonderful soups, appetizers or desserts?
Did our server check back with you during your meal?
Was our dining room comfy & clean?
Was our restroom sparkling?
How was our beer and liquor selection?

Entrees you Ordered
Please list the Entree you ordered:
Please rank your menu selections:
Please list the Entree you ordered:
Please rank your menu selections:
 

Additional Information:
   


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