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FAMILY FEEDBACK FORM

In order to serve you better, we know that it is important to accept any criticisms along with praise in order to excel in our cause. We encourage you to provide us with your genuine comments on how well we served you in your time of need. 


Personal Information
Name: 
Address:
City:    Postal Code:
Phone:


Funeral home related feedback

Name of the Funeral Director who assisted you:


1. Why did you choose our funeral home? (Choose all that apply)
Service was pre-arranged Religious affiliation
Church/clergy affiliation Recommendation

Previously served family

Quality and reputation
Location

Facilities

Advertisement Prices 

                          Other:

                         

2. What concerned you most about making funeral arrangements?
Coping with shock of the loss Choosing appropriate service
Potential expense Choosing casket or urn
Not knowing what to expect
Other (please specify):  

3.During the arrangement conference, did you find the information provided helpful in making your selections? (please select only one)
Yes No Not sure

4. Was our staff courteous and helpful?
Yes No Not sure

5. Would you please rate the following IF THEY APPLY. (choose only one response for each item)
Satisfied Neutral Dissatisfied
Initial contact with our firm
Arrangement Conference
Merchandise Selection
Appearance of Deceased
Visitation
Explanation of selection, services & prices
Appearance of facilities
Staff attitude


6. Please respond to the following statement,"The prices charged by our funeral home gave us value for our wants, needs and choices."  (Choose the one that applies)
I Agree I Disagree Not Sure

 

7. Was the service performed as you had arranged?

Yes No Not Sure

8. Would selections have been easier if the information on funeral service options and costs had been available to you previously?

Yes No Not Sure

9. Do you think prearranging your funeral is a good idea?

Yes No Not Sure

10. Would you like information on prearranging a funeral?

Yes No Not Sure

11. Based on your experience, would you recommend our funeral home to others? (If the answer is no, please explain below in the provided comments box)
Yes No Not Sure

Additional Comments or Suggestions


 

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