Existing Customer Survey | Smith Family Funeral Home

Free Text

Advance Funeral Planning Survey

Which age range do you fall into?

Under 25

26-40

41-65

66 or older

What is your current employment status?

Employed

Retired

Unemployed

Is there an honorably discharged Veteran in your household?

Yes

No

Have you ever been responsible for making funeral arrangements?

Yes

No

When have you most recently been responsible for making funeral arrangements?

Within last 12 months

12-24 months ago

Over 2 years ago

Never

Have you ever considered a prepaid funeral plan?

Yes

No

How much might you expect to pay for a funeral?

Which of the following would you choose for yourself?

Traditional Burial

Cremation

Have you made firm plans and arrangements for cemetery property?

Yes

No

Do you maintain up-to-date biographical information and accurate family records to assist you or a loved one with funeral planning?

Yes

No

Would it give you peace of mind to know that you could do the planning in advance and that your family would not have to make these arrangements?

Yes

No

Would you like free information about funeral planning and the types of services that are available?

Yes

No

Free Text

Contact Information

Name

Age

Spouse's Age

Address

City

State

Zip Code

Telephone Number

Email

Menu

Advance Funeral Planning Survey

Customer Survey