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Deceased
First Name
Address
Apt, Suite, Etc.
Zip Code
City
State
Telephone
Email
1. Thinking about your experience working with our funeral home, how would you rate our overall satisfaction?
Excellent
Acceptable
Unacceptable
2. What is the likelihood that you would recommend our funeral home to someone else if the situation presents itself?
Definitely
Maybe
Unsure
3. What is the primary reason you chose to work with our funeral home ? (Please check one only)
Previous Experience
Location
Funeral Home Reputation
Someone Recommended
Loved One had Prearranged
Price
Other
other
Condition of Facility
Excellent
Acceptable
Unacceptable
Variety of Services /Merchandise Options
Excellent
Acceptable
Unacceptable
Value of Price Paid
Excellent
Acceptable
Unacceptable
Comments
Submit
5
6. Which of the following types of information can we provide to help you?
Grief Support
Cemetery Property/Memorialization
Pre-planning
Other:
6A
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