Thank you for taking some time to provide us your feedback on your experience with us. Our goal is to provide families with exemplary service and to help create a meaningful remembrance event for your loved one. Your feedback will help us know how we are doing and where we can improve.

1. These first questions help us better understand the demographics of those filling out the surveys.

Full Name (First and Last name)
Relationship to the deceased
AgePhone Number AAA-XXX-YYYY
Address
CityStateZip

2. Please identify what influenced your funeral home choice : ( Multiple answers may apply )

Church Affiliation Service Club Affiliation Pre-Arrangement
Recommendation from Clergy Facilities Location
Recommentation from Friends Reputation Price
Recommentation from Family Ability to Personalize Service Other
Previously Served Our Family Advertising
Hospice Referral Hospital Referral

3. Please identify the types of advertising you've encountered for Memorial Mortuaries and Cemeteries :

Funeral Home Website Billboard Newspaper :
Church Bulletin Television Other :
Direct Mail Internet Yellow Page

4. How likely would you be to recommend our funeral home to others?

Not at all likely | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | Extremely likely

5. In the event you had to plan another funeral, how likely would you be to use our funeral home again?

Not at all likely | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | Extremely likely

6. Did you use an internet search to find this funeral home? Yes : No

If yes, what words did you use in your search?

7. When deciding which funeral home to use, where did you look for information on funeral homes? (Multiple answers may apply)

Family Members Advertisements Phone Book
Friends Social Media Funeral Home's Website
Internet Search Magazines Other:

8. How would you rate the following:

(Please skip if it does not apply)PoorExcellent
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The funeral director who arranged the funeral or memorial service?
The options presented for personalizing the funeral of your loved one?
The merchandise selection such as caskets, vaults, urns, etc.?
The customer service of the funeral director who directed the funeral or memorial service you selected?
The appearance of your loved one (if you had a viewing)?
The staff’s professionalism?
The funeral home’s attention to detail?
The appearance of the funeral home facilities?
Overall, how would you rate this funeral home?

9. Was this the first time you used our funeral home? Yes : No

10. Who, if anyone, was especially helpful to you?

11. How was this person helpful ?

11. What, if anything could have been done to improve our firm’s service to you?

12. Was the funeral service for your loved one pre-paid? Yes : No

13. Did the pre-paid arrangements help ease the burden of the arrangement process? Yes : No

14. Would you be interested in learning more about pre-paid arrangements for yourself? Yes : No

Additional Comments: