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 brief questions that follow are designed to help us know more about what people want and need at the most difficult time. The results will help us improve our level of service by pinpointing what is most important to you. Please answer these questions as completely as you can.
1. WHAT IS YOUR CURRENT AGE?
  35-44
  45-54
  55-64
  65-74
  75 and over
 
2. ARE YOU CURRENTLY:
  Employed
  Retired
 
3. HAVE YOU EVER BEEN RESPONSIBLE FOR MAKING FUNERAL ARRANGEMENTS?
  Never
  Past 12 months
  Past 12-24 months
  Over 24 months ago
 
4. IF YOU HAVE GIVEN ANY THOUGHT TO THE SUBJECT, WHICH OF THE FOLLOWING WOULD YOU CHOOSE FOR YOURSELF?
  Burial
  Cremation
 
5. HOW IMPORTANT TO YOU PERSONALLY IS THE LOCATION (PROXIMITY) OF THE:
Funeral home?
  Very important
  Somewhat important
  Not very important
  Not important at all
   
Cemetery?
  Very important
  Somewhat important
  Not very important
  Not important at all
 
6. HOW MUCH MIGHT YOU EXPECT TO PAY FOR A FUNERAL?
  Under $2,000
  $2,000-$3,999
  $4,000-$5,999
  $6,000-$7,999
  $8,000-$9,999
  Over $10,000
 
7. DO YOU MAINTAIN UP-TO-DATE BIOGRAPHICAL INFORMATION AND ACCURATE FAMILY RECORDS TO ASSIST YOU OR A LOVED ONE WITH FUNERAL PLANNING?
  Yes
  No
 
8. HAVE YOU MADE FINAL PLANS AND ARRANGEMENTS FOR:
Cemetery property?
  Yes
  No
   
The type of funeral service you desire?
  Yes
  No
 
9. ARE YOU AWARE THAT A PREARRANGED FUNERAL PLAN MAY HELP YOU QUALIFY FOR MEDICAID?
  Yes
  No
 
10. ARE YOUR LOVED ONES AND FAMILY MEMBERS AWARE OF WHAT YOU WOULD PREFER FOR YOUR OWN ARRANGEMENTS?
  Yes
  No
 
11. IN THE EVENT OF YOUR DEATH, WHO WOULD MAKE FUNERAL ARRANGEMENTS?
  Spouse
  Child(ren)
  Family member
  Other
 
12. WOULD IT GIVE YOU PEACE OF MIND TO KNOW YOU COULD DO THE PLANNING IN ADVANCE AND THAT YOUR FAMILY WOULD NOT HAVE TO MAKE ARRANGEMENTS?
  Yes
  No
 
13. WOULD YOU LIKE FREE INFORMATION ABOUT FUNERAL PLANNING AND THE TYPES OF SERVICES WHICH ARE AVAILABLE?
  Yes
  No
  If yes, please complete the following information:
 
  Name
  Address
  Phone
  Email