12519 Buckeye Road
Cleveland OH
(216) 921-6400
Our Family Feedback Form
Please enter the name of the deceased or next of kin:
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 applies)
Service pre-arranged
Religious affiliation
Recommended by clergy
Recommended by friend
Previously served family
Reputation
Location
Facilities
Prices
Other:
2. How did you hear about our Funeral Home?
Newspaper
Yellow Pages
Recommended by clergy
Getting to know you
Funeral Home Employee
Reputation
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?
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
Arrangement Co-Ordination
Appearance of facilities
Staff Attitude
6. 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
7. 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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