How are we doing?
Answers marked with a * are required.
1. 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.
 
 
1. Demographic Information *
First Name
Middle Name
Last Name
Address
City
State
Zip Code
Phone Number
 
 
 
2. What is your age?     *
      
 
 
 
3. Have you attended a funeral at Broyles-Shrewsbury Funeral Home? *
      
 
 
 
Please tell us what you think about our funeral home and the services we provide:
 
 
 
4. Quality of Service *
      
 
 
 
5. Pricing *
      
 
 
 
6. Have you ever been responsible for making funeral arrangements? *
      
 
 
 
7. If you have given any thought to the subject, which would you choose for yourself? *
      
 
 
 
Are you aware of all choices available for:
 
 
 
8. Burial: *
      
 
 
 
9. Cremation: *
      
 
 
 
10. How much would you expect to pay for a funeral? *
      
 
 
 
11. Do you own Cemetery Property? *
      
 
 
 
12. If Yes, what cemetery?
 
 
 
13. In the event of your death, who would be responsible for making the arrangements? *
      
 
 
 
14. Do your loved ones know what type of services you would prefer? *
      
 
 
 
15. Are you aware that Pre-Paid funeral Plans exist? *
      
 
 
 
16. Are you aware that prelanning your final arrangements can help you qualify for Medicaid? *
      
 
 
 
17. Are you concerned about "emotional overspending" by the person planning your funeral if the decisions are left to be made at a difficult time? *
      
 
 
 
18. Would you like to receive free information on any of the following at no obligation? Check all that apply. *
       		 
 
 
19. How and when would you like to be contacted?
Phone
Best Time to Call
Email
 
 
 
20. Please leave any comments or suggestions you may have for us.
 
 
 
 
 

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