Cafe & Restaurant Acoustic Index On-line Form

Please complete the form below and submit your results.

(Entries marked with an asterisk * are mandatory)

Name of Cafe/Restaurant: *

City where venue is located: *

Date of visit: *

Month

Day

Year

Your name, or name of function (Optional):

Your email address *

In case we need to contact you regarding your rating

Your Age *

How many people at your table: *

Please rate the following questions with a value from 1 to 5.

How much noise do you like in cafes/restaurants? (1 = A lot, 5 = None) *

How much did the level of noise adversely affect your enjoyment of the dining experience? (1 = A lot, 5 = Not at All) *

Did you experience any difficulties conversing with other people as a result of noise? (1 = A lot, 5 = Not at All) *

How much would your experience of noise in this venue adversely affect your decision to return? (1 = A lot, 5 = Not at All) *

How busy was the cafe at the time of your visit? (1 = Almost empty, 5 = Full) *

At what level was music playing while you were eating? (1 = Too Loud, 5 = None) *

Additional Comments:

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