Feedback Form | Blake's Lotaburger

Are you a Blake's Lotaburger Customer or Employee?*

Customer
Employee

This page is for employees to give ANONYMOUS feedback about their working experience.

ALL QUESTIONS ARE OPTIONAL. While you may wish to remain anonymous, and can still do so, please remember that it is much easier to investigate allegations if the H.R. Department has your contact information. Your name will be held in strictest confidence within the Human Resources Department. Our direct number is: 505- 884-2160 x 5004.

Your Name

First Last

(optional)

Phone

(optional)

At which location do you work (Store #)?

Is this regarding a(n)....

Immigration Issue
Criminal Activity Report
General Complaint
Other

If "other", please describe here

Name(s) of employee(s) involved

Comments or additional information

Would you like to contacted?

Yes
No

If yes, please provide your phone number and/or name above

Guest Information

Name*

First Last

Phone*

Email*

Address*

Street Address Address Line 2 City State ZIP Code

About Your Visit

Are you a frequent customer of Blake's Lotaburger?*

I am a frequent customer of Blake's Lotaburger (1-2 times a week)
I am a somewhat regular customer of Blake's Lotaburger (1-2 a month)
This was my first experience at Blake's Lotaburger
Other

If "other" please specify:

Did you visit Blakes for:*

Breakfast
Lunch
Dinner

Which location did you visit?*

Please provide your order number*

(5 digit number at the top of the receipt)

Time of Order*

Date of Order*

How was the crew's appearance?*

Clean & Neat	No Opinion	Needs Improvement

Our crew was...*

Courteous & polite	Not particularly courteous but efficient	Not particularly efficient but courteous	Neither courteous or efficient

Overall, my experience at Blake's Lotaburger...*

Exceeded my expectations	Met my expectations	Fell short of my expectations

Anything else you'd like to share about your visit?

Would you like to be added to our email list?*

Yes
No

Would you like to be contacted?*

Yes
No