Questionnaire

My initial contact with the funeral home left me feeling (check applicable boxes):

Confident

Relieved

Unsure

Apprehensive

Worried

Where did you find the funeral home's phone number of e-mail address (check applicable boxes)*:

Yellow Pages

White Pages

Newspapers

Internet

Other

What was your reason for choosing our funeral home? (check applicable boxes):

Reputation

Prior services

Reference

Other

Was the staff courteous?*:

Yes

No

Comments:

The following describes my Funeral Director (check applicable boxes)*:

Comments:

My Funeral Director explained the funeral service options well?*:

Yes

No

Comments:

Was the funeral service provided to your satisfaction?*:

Yes

No

Comments:

What could we have done differently?:

Would you like to receive information about funeral pre-planning?*:

Yes

No

Name:

Email:

Phone number:

Additional Comments/Suggestions:

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