Our Family Feedback Form

Online Tributes

Comments & Suggestions

FAMILY FEEDBACK FORM

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:

A Basic Service Related Feedback

Name of the Funeral Director who assisted you:

1. Why did you choose A Basic Services? (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 A Basic Service?

	Newspaper	Yellow Pages
	Recommended by clergy	Getting to know you
	A Basic 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

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
Arrangement Co-Ordination
Appearance of facilities
Staff Attitude

6. Please respond to the following statement,"The prices charged by A Basic Service were reasonable." (Choose the one that applies)

I Agree

I Disagree

Not Sure

7. Based on your experience, would you recommend A Basic Service to others? (If the answer is no, please explain below in the provided comments box)

Yes

Not Sure

Additional Comments or Suggestions