EmailMe Form - (Example)Restaurant Survey Theme

What is the first restaurant that comes to mind when you think about healthy cuisine? *

Where have you seen advertisements for Fresh Choice? *

Which Fresh Choice dishes have you tried or heard of? *

How would you rate the quality of food at Fresh Choice? *

How would you rate the value Fresh Choice provides? *

Would you recommend Fresh Choice to a friend? *

Yes, definitely!

Maybe

Never

Date of last visit or next visit. *

MM / DD / YYYY

Email

Optional