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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

1. Name of the Funeral Director who assisted you:

2. Overall, what condition was the funeral home in?     
Excellent      Good      Fair      Poor      Unacceptable

3. During the arrangement conference, did you find the information provided helpful in making your selections? 
Yes        No          Not Sure

4. Was the funeral directed in a professional manner?
Yes        No          Not Sure

5. Was the staff sensitive to your needs at the funeral home and funeral service?
Yes        No          Not Sure

6. 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
Arrangement Co-Ordination
Appearance of facilities
Staff Attitude

7. How was the funeral home's attention to details?
Excellent      Good      Fair      Poor      Unacceptable

8. Which words best describe the funeral director that assisted you?    
Caring Concerned Friendly Supportive Warm
Cold Impatient I nconsiderate I nsincere Pushy

9. Please respond to the following statement,"The prices charged by our funeral home were reasonable." (Choose the one that applies)
I Agree      I Disagree      Not Sure

10. 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