Pippins Restaurant

Electronic Feedback Form

So now that you're here, you'll see that this form allows you to share with us your thoughts and opinions about us, as well as some general info.
Name:  
Address:  
City:     Zip:  
State:       Province:  
Country:     Phone:  
Email:  
How did you
hear about us?		  
   
Tell us about your visit to Pippins Restaurant    
   
Date of visit:     Time of visit:  
Server's Name:     Cleanliness:  
Service:     Friendliness:  
Food:     Atmosphere:  

How often do you visit us? 

When in the area, will you dine with us again? Yes No

Comments:
 
Would you like us to contact you?
Sure, email me. No, thank you.
If so, what info would you like?
Other comments / opinions:
   

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