2028 Highway 35
Wall, NJ 07719
Phone: (732) 449-6900 Fax: (732) 449-6905

505 Burnt Tavern Road
Brick, NJ 08724
Phone: (732) 899-8600 Fax: (732) 899-8607

FAMILY FEEDBACK FORM

In order to serve you better, we know that it is important to accept any criticisms along with praise to excel in our business. 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:
Funeral home related feedback

Name of the Funeral Director who assisted you:

1. Why did you choose our funeral home? (Choose all that apply)
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 our funeral home?
Newspaper Yellow Pages
Recommended by clergy Getting to know you
funeral home 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 No Not Sure

4. Was our staff courteous?
Yes No Not Sure

5. Would you please rate the following, if the apply. (choose only one response for each item)
Satisfied Neutral Dissatisfied
Initial contact with our firm
Arrangement Conference
Merchandise Selection
Appearance of Deceased
Visitation
Arrangement Co-Ordination
Appearance of facilities
Staff Attitude


6. Please respond to the following statement,"The prices charged by our funeral home were reasonable." (Choose the one that applies)
I Agree I Disagree Not Sure

7. Based on your experience, would you recommend our funeral home to others? (If the answer is no, please explain below in the provided comments box)
Yes No Not Sure
Additional Comments or Suggestions