Your Information:
Your Name: *
Your Street:
Your City/Province:
Your Postal Code:
Your Phone Number: *
Your Email: *
Age Group: *
18 & under
19-30
31-40
41-55
56 +
Occupation:
Information About Restaurant Location:
Restaurant: *
-SELECT RESTAURANT- AB - Brooks - Trans Canada Hwy AB - Calgary - 6510 - 4th Street N.E. AB - Calgary - 250, 10233 Elbow Drive SW AB - Calgary - 1619 - 46 Street NW AB - Calgary - 2505 Macleod Trail South AB - Calgary - 511 McKnight Blvd NE AB - Calgary - 14315 Macleod Trail South AB - Calgary - 42148 Highway #1 (Hwy #1 & #22 Junction) AB - Calgary - 125 Stewart Green SW AB - Calgary - 102, 920-36 Street NE AB - Calgary - 7007-11 Street SE AB - Camrose - 5606-48 Avenue AB - Cold Lake - 4207-50 Street AB - Crossfield - Highway #2 North AB - Edmonton - 9910 - 108A Avenue AB - Edmonton - 12503-127 Street AB - Edmonton - 17006-90 Avenue AB - Edmonton - 4503 Gateway Blvd AB - Edmonton - 7451 Roper Road NW AB - Edmonton - 13232-97 Street AB - Edmonton - 5011-130 Avenue AB - Edmonton - 9555-82 Avenue AB - Edmonton - 1320 Calgary Trail SW AB - Fort McMurray - 325 Sakitawa Trail AB - Fort Saskatchewan - 8815-101 Street AB - Grande Prairie - 13211-100 Street AB - Lethbridge - 2720 Mayor Magrath Drive S AB - Lethbridge - 205 Scenic Drive South AB - Medicine Hat - 1343 Trans Canada Way SE AB - Nanton - Box 1649, 2810 - 21 Ave. North AB - Red Deer - 112, 2325-50 Avenue AB - Red Deer - 37452 A Highway 2 AB - Sherwood Park - #78 - 975 Broadmoor Blvd. AB - Spruce Grove - 20, 100 Jennifer Heil Way AB - Sylvan Lake - #3 Hwy 11 A (Sylvan Corner Centre) BC - Fort St. John - 11724 Alaska Rd (SS Site 2, Comp8) MB - Brandon - 1525-18 Street MB - Brandon - 100 Highland Avenue MB - Oak Bluff - Perimeter & Hwy #3 SK - Kindersley - Hwy #7 & Main Street (Box 1866) SK - Lloydminster - 4903-44 Street SK - Moose Jaw - 1702 Main Street North SK - North Battleford - Hwy #16 Bypass SK - Prince Albert - 1201-2 Avenue West SK - Regina - 1616 Albert Street SK - Saskatoon - 405 Circle Drive East SK - Swift Current - Rural Delivery Hwys #1 & #4 SK - Yorkton - Hwys #9 & #16 (Box 1630)
Address of Restaurant:
City/Province:
Date & Time Visited: *
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Newspaper
Radio Station
TV
Driving By
Word of Mouth
Other:
# of people in your party: *
Did you have to wait for a table? *
No
Yes
How Long?
Was the restaurant clean? *
Was your table clean?
What area was not clean?
Server's Name:
Did you have *
Breakfast
Dinner
Lunch
Please Rate Our Food On:
Taste: *
Excellent
Very Good
Fair
Poor
Temperature: *
Portion Size: *
Price: *
Please Rate Your Service Today:
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Friendliness: *
Attentiveness: *
Accuracy: *
Additional Information:
How would you rate this restaurant? *
How often do you visit Humpty's Family Restaurants? *
1st Time
Weekly
Monthly
One or Two times a year
Other Comments and Suggestions: