Champps DBQ - Guest Comment Card

Your opinion of our restaurant is very important to us. Please take a few minutes to tell us about your experience.

All comments will be kept confidential.

Thank you so much for your business and loyality and thank you for your time.

5 = excellent 1= poor

Food Quality	1 2 3 4 5
Menu Variety	1 2 3 4 5
Service	1 2 3 4 5
Atmosphere	1 2 3 4 5
Cleanliness	1 2 3 4 5
Overall Experience	1 2 3 4 5
Server's Name
Date and Time
How frequently do you dine with us?
Would you recommend us to a friend?	Yes No
What would you change about us?
What should stay the same?
Name
Email Address:
City
State
Zip Code
Phone
Birth Date
Would you like to join our Fan Club?	Yes No

Locally owned and operated

click here to make a reservation
at the Dubuque Hotel and Conference Center