Skip to content
Clearmans 2023 Receipt survey
Clearmans 2023 Receipt survey
*
1.
What location of ours did you visit?
(Required.)
North Woods Inn San Gabriel
North Woods Inn Covina
North Woods La Mirada
Steak n' Stein
*
2.
Email - required for entry into the $75 monthly Gift Card drawing
(Required.)
*
3.
Phone Number - required for entry into the $75 monthly Gift Card drawing
(Required.)
*
4.
Receipt Number - required for entry into the $75 monthly Gift Card drawing
(Required.)
5.
What date did you visit us?
Date / Time
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
6.
What time of day did you visit us?
Date / Time
Hour
Time
:
Minutes
AM/PM
-
AM
PM
7.
Was this your first time dining here?
Yes
No
8.
My food order was accurate
Yes
No
9.
Did your food arrive in a timely manner?
Yes
No
10.
Did the quality of food meet your expectations?
Strongly agree
Agree
Disagree
Strongly disagree
11.
The Staff and Service were excellent
Strongly agree
Agree
Disagree
Strongly disagree
Addition comments welcome:
12.
Are you happy with our variety of beer selections?
Yes
No
Additional beer suggestions:
13.
If you ordered a cocktail, was it made to your liking?
Yes
No
Additional comments welcome:
14.
The food is good value for the money spent
Strongly agree
Agree
Disagree
Strongly disagree
Additional comments welcome:
15.
What entree would you like to see added to the menu?
16.
What is your age?
Under 18
18-24
25-34
35-44
45-54
55-64
65+
17.
What zipcode is your home located? (enter 5-digit ZIP code; for example, 00544 or 93405)
Current Progress,
0 of 17 answered