Our Family Feedback Form

FAMILY FEEDBACK FORM

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

Personal Information

Name:
Address:
City:	Postal Code:
Phone:

funeral home Related Feedback

Name of those who assisted you:

1. Why did you choose our funeral home? (Choose all that applies)

Location

Reputation

Previously served family

Recommended by friend

Family Owned

Recommended by clergy

Service pre-arranged

Facilities

Service Choices

Other:

2. How did you hear about our funeral home?

	Reputation	Yellow Pages
	Recommended by clergy	Community Involvement
	Funeral home Employee	Newspaper
	Other (please specify):

3.During your arrangement conference, did you find the information provided helpful in making your selections and choices? (please select only one)

Yes

Not Sure

4. Was our Staff Courteous?

Yes

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 your loved one
Visitation
Arrangement Co-Ordination
Appearance of facilities
Staff Attitude