Blue Pacific 
Sushi & Grill


 

 


Send Us Your Comments

To better serve our valued customers, Please fill out this quick survey with any of your concerns.  They will be addressed immediately.  Thank You

  1. Please provide the following contact information:

    Name
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Home Phone
    E-mail

  2. Please describe yourself:

    Date of Birth
    Sex Male Female

  3. Would you like to be on our mailing list for monthly specials ?      Yes No

  4. Enter the date of your last visit :   -- mm/dd/yy

  5. Enter the time of your last visit:   

  6. Party of how many ?  

  7. How would you rate your overall experience of your last visit ?

    bad      poor      average      fair      good

  8. Do you have any questions, comments or suggestions about our :

    Restaurant  Server      Food        Wait Time 
Take Out    Website     Other       None

  9. Place your questions, comments or suggestions here: 

 

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