Your information: (optional) Anonymous First name Last name Address City Postal code/zip code Country Province/State Select... Canada United States of America Select... Anonymous Telephone E-Mail

Your experience: Experience type: Select... Comment on a visit in restaurant Comment on a retail product Guest suggestion Loyalty program Date and Time:   Hour:    5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20   Minute:    0 15 30 45

How did you hear about us? Select... Newspaper Word of mouth Mail Radio Magazine Television Other   Disappointing Exceptional   Your arrival: 1 2 3 4 5 6        Length of wait before being seated   Disappointing Exceptional   The restaurant: 1 2 3 4 5 6        Cleanliness        Atmosphere        Comfort   Disappointing Exceptional   The service: 1 2 3 4 5 6        Time to take the order        Help and suggestions from your server        Quality of service   Your meal:        You selected: Select... Savoury crepes Sweet crepes Fresh fruit Eggs Omelettes French toast Pancakes Waffles Sandwiches Lunch menu Other   Disappointing Exceptional 1 2 3 4 5 6        Preparation time        Taste        Temperature of your meal        Quantity        Our coffee        Value        Presentation        Freshness   Disappointing Exceptional 1 2 3 4 5 6   How would you evaluate your general experience: Yes No                               Would you recommend this restaurant to a friend?

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