Name of Restaurant

Location (street, town)

Parking:
Is there well-marked accessible parking (including access aisles) at or close to the restaurant?

Your Rating of Parking:
Below Average: Not Accessible!
Average: Somewhat Inconvenient
Above Average: Fully Accessible

Your comments on Parking:

Getting Into the Restaurant
Can you get inside in a wheelchair using the same entrance as everyone else?
How easy was it?

Your rating of Getting into the restaurant:
Below Average: I could not get in!
Average: Inconvenient or a separate entrance
Above Average: Fully Accessible

Your comments on getting in:

Inside Access
Can you maneuver around using your chair, cane, crutches, etc. easily? (Are there inaccessible areas? Are tables accessible? Can you sit up closeto the table?)

Your rating of Inside Access:
Below Average: I could not get around
Average: Inconvenient but do-able
Above Average: Fully Accessible

Your comments on inside access:

Restroom Access
Are both men's and women's rooms accessible? (Can you get into the bathroom, move around comfortably, use the facilities? Are there grab bars?)

Your rating of Restroom Access:
Below Average: I could not use the facilities
Average: Inconvenient but do-able
Above Average: Fully Accessible

Your comments on restroom accessibility:

Accommodations
If you asked for a specific accommodation (such as a large font or braille menu, have the menu read to you, welcome your guide dog), was it provided?

Your rating of Accommodations:
Below Average: Not accommodating
Average: Minor problems
Above Average: Fully accommodating

Your comments on accommodations:

Overall experience
Did you enjoy your dining experience? Was the food and service good? Did the server treat you with respect?

Your rating of Overall Experience:
Below Average
Average: It was OK
Above Average: I enjoyed it!

Your comments on overall experience:

Fields below are optional and confidential. We only ask for this info in case we need to contact you for clarification.

Your Name:

Your Address:

Your Email:

Your phone number:

What accommodations do you use?

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