ViVa Center for Nutrtion & HealthyBelly.com - ViVa's Healthy Dining Guide, vegetarian dining guide, dining guide, healthy dining travel guide

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Questionnaire

If you're a vegetarian, vegetarian friendly or vegan restaurant, a natural foods market, juice bar, or other health conscious eating establishment, you've come to the right place! We can now help people find you as they travel around the United States for business and pleasure.

In an effort to offer a complete guide to healthy eating across the country, we need to gather as many details as we can. Please spare a few moments to fill out this form as completely as possible so we can include your establishment in future editions of "ViVa's Healthy Dining Guide". Thanks for your support!

NOTE: Fields in Red Are Required.

	YES! Include my business in your next issue.
	This is a		NEW		UPDATED listing.

Business Name:			Contact:
Address:			City:
State:			Zip:
Phone:			Fax:
Email:			Web Site:

Hours of Operation (include days & times):
Type of Restaurant/Market:
Description of Food:
Specialties:

CUISINE (check all that apply):
Natural Foods	Vegetarian	Vegan
Vegetarian Friendly	Macrobiotic	Health Food
Ethnic Specialties:
Other:

JUICES (check all that apply):
Fresh Juices	Fruit Juices Only	Fresh Wheat Grass Juice
Smoothies	Other:

BEVERAGES (check all that apply):
Full Service Bar	Wine & Beer	BYOB
Espresso/Cappuccino	Other

SERVICE (check all that apply):
Full Service	Buffet/Cafeteria Style	Take-out
Delivery	Outdoor Dining	Catering
Other:

SMOKING POLICY:
Smoke-Free	Smoking Allowed In Designated Areas

DRESS CODE:
Casual	Jacket Required	Other:

HANDICAP ACCESS:
Yes	No

RESERVATIONS (check all that apply):
Required Always	Recommended	No Reservations Required
Required (when):

PAYMENT (check all that apply):
VISA	MASTERCARD	AMERICAN EXPRESS
DISCOVER	DINER'S CLUB	Credit Cards NOT Accepted

AVERAGE ENTRÉE PRICE RANGE:
$10 or Less	$10 to $19	$20 to $34	$35 Plus

COMMENTS (please share what makes your business special, e.g. entertainment, group accommodations, etc):

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