First Name *
Last Name*
Email *
Phone Number *
What is the most memorable thing you remember about our services? *
What is the most memorable thing you recall when you first arrived at the funeral home to make arrangements? *
During the arrangements, were there any words or phrases used that you did not fully understand? *
If you could teach our staff one thing, what would it be? *
If you could change one thing about our funeral home, what would it be?*
What is one thing that you would have liked to have done that was not done?*
Did you find our pricing to be affordable and show value received? * Make a SelectionYesNo
Were the facilities clean and comfortable? * Make a SelectionYesNo
Was there anything that we could have done to make things easier for you?*
If viewing of the decedent was chosen, was the decedent presented to your satisfaction?*
Would you refer us to other families and friends?* Make a SelectionYesNo
How timely were we in assisting you in receiving the death certificates? * Make a SelectionExcellentVery GoodGoodPoorVery Poor
If you haven’t pre-arranged your own services, what is the main reason? * Make a SelectionI'm too youngI'm too oldNo money for pre-arrangementMy family will handle itI have plenty of insurance
Would you like information about funeral pre-planning sent to your home?* Make a SelectionYesNo
Are there any ways we can improve our services to make your experience better? *
In choosing us, how were you referred?: Make a SelectionSearch EngineFamily/FriendNewspaperAdvertisementTelevisionRadioHospiceOther
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