Restaurant Complaint and Incident Report Form Template

The form itself

Blocks included

These are the exact starting questions and content blocks that will appear in your ResponseMint workspace.

1. 01
   Content · Grouped page

   Before you report

   Dietary answers help the team prepare but are not a guarantee. Confirm severe allergy requirements directly with the restaurant.

2. 02
   Dropdown · Grouped page

   What does this report concern?

   • Order accuracy
   • Allergen concern
   • Service
   • Billing
   Required
3. 03
   Date

   When did it happen?

   Required
4. 04
   Dropdown

   Which part of the experience was involved?

   • Reservation
   • Arrival
   • Meal
   • Payment
   Required
5. 05
   Long answer

   Please describe what happened

   Required
6. 06
   Multiple choice

   What impact did this have?

   • Minor inconvenience
   • Could not complete the task
   • Financial or property impact
   • Safety or wellbeing concern
   Required
7. 07
   Long answer

   What resolution would you consider helpful?

8. 08
   File upload

   Add a supporting photo or document (optional)

9. 09
   Multiple choice · Grouped page

   How should we handle follow-up?

   • Contact me by email
   • Contact me by phone
   • I do not need a reply
   Required
10. 10
    Email · Grouped page

    Email for follow-up (optional)