12519 Buckeye Road
Cleveland OH
(216) 921-6400
Survey Form    
Please enter the name of the deceased or next of kin:

Surveys can assist us greatly in understanding the needs and views from the community. We do appreciate and value all of your feedback.  The information we gather is used to help us to improve on service.  Wanton Horne Chapel of Peace Funeral Home is constantly adapting to the specific needs of the community.

Personal Information

Province / State:
Postal / Zip Code:
Phone Number:

You are? Married  Single  Widowed

Your age?

Do you have Children? Yes No

If so, How many Children?

Employment Status? Working  Retired

Survey Information

Do you have a Will? Yes  No

Has it been updated lately? Yes  No

Have you ever made funeral arrangements before? Yes  No

If 'Yes':

Within the Past Year  1 to 3 Years  Over 3 Years

How much do you think funerals cost?
$500 - $999  $1,000 - $1,999 $2,000 - $3,999
$4,000 - $5,999 $6,000 - $8,500 Over $8,500

Have you been informed that Pre-Arranged and Funded funeral plans exist?

Yes  No

Do you have a pre-paid funeral plan?

Yes  No

If "No", have you ever considered a prepaid funeral plan?

Yes  No

Have you purchased Life Insurance to help pay for your funeral arrangements?

Yes  No

If "Yes", does the beneficiary understand the policy and the reason for having this policy?

Yes  No

When choosing your arrangements, would you choose?
Burial  Cremation  Mausoleum  Entombment  Not Sure

Have you purchased cemetery property?

Yes  No

In the event of your death, who will be responsible for making your funeral arrangements?

Spouse  Children Other family member  Other

Who will be responsible for making the payment of your arrangements?

Spouse  Children Other family member  Other

Does the person making the arrangements know of all your preferences, including casket, flowers and services?

Yes  No

Would making your own arrangements give you peace of mind knowing that you have planned and paid for your own funeral arrangements?

Yes  No

Do you feel that making your own funeral arrangements are as important as keeping your life insurance and will up to date?

Yes  No

If you have any further comments or questions that we help us then please use the box that we have provided below:

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