First Name

Surname

E-Mail

Restaurant Visited Restaurant visited Covent Garden Chelsea

Visit Date Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2010 2011 2012

Time arrived? Please select... Lunch Afternoon Pre theatre Dinner Post Show Late night

What did you have? Please select... Drinks in the Bar Drinks & Food in the Bar Meal in the restaurant Drink at the bar then a meal in the restaurant

Quality of food Please select... Excellent Good Fair Poor

Service Please select... Excellent Good Fair Poor

Atmosphere Please select... Excellent Good Fair Poor

Qualty of Drinks Please select... Excellent Good Fair Poor

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