Name *

First Name

Last Name

If placed on a special/restricted diet, how was it explained to you?

Please choose from the following

Very Poor

Poor

Fair

Good

Very Good

Was the portion satisfactory?

Very Poor

Poor

Fair

Good

Very Good

How likely was/is it that you get the food you selected?

Very Poor

Poor

Fair

Good

Very Good

Courtesy of the person who served you

Very Poor

Poor

Fair

Good

Very Good

Quality of the food

Very Poor

Poor

Fair

Good

Very Good

Temperate of the food

Was cold food as cold as expected and/or was hot food as hot as it should be?

Very Poor

Poor

Fair

Good

Very Good