Survey

We need your help. We are conducting a survey to determine how members of our community plan for one of the hardest things a family has to face: the death of a loved one.

The results will help us improve our level of service by pinpointing what is most important to you. We thank you in advance for your participation.

Please enter your contact information.

First name is required
First Name :*
Last name is required
Last Name :*
Email address is required
Email address is invalid
Email :*

Phone# :
Address :

Please answer the question before moving on

1. What is your current age?

34 or younger
35 - 44
45 - 54
55 - 64
65 - 74
75 or over

Question 1 of 11

2. Are you aware that a prearranged funeral plan may help you qualify for Medicaid?

Yes
No

Question 2 of 11

3. In the event of your death, who would make your final arrangements?

Spouse
Children
Family Member
Other

Question 3 of 11

4. Are your loved ones aware of what you would prefer for your own arrangements?

Yes
No

Question 4 of 11

5. Have you pre-arranged your plans for Funeral Services ?

Yes
No

Question 5 of 11

6. Have you pre-arranged your plans for Cemetery Property?

Yes
No

Question 6 of 11

7. How much might you expect to pay for a funeral?

$3,000 - $5,000
$5,000 - $10,000
$10,000 - $15,000
$15,000 +

Question 7 of 11

8. Have you given any thought to the subject, which of the following would you choose for yourself?

Burial
Cremation

Question 8 of 11

9. Have you ever been responsible for making funeral arrangements?

Yes
No

Question 9 of 11

10. Are you currently:

Employed
Retired

Question 10 of 11

11. I would like to receive a free pre-planning guide so I can record my wishes in writing for the ones I love most?

Yes
No

Question 11 of 11

Thank you for your time. Finally, would you like free information about pre-planning cemetery, and funeral and the types of services which are available?