Our Family Feedback Form

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Our Family Feedback Form

	EVEREST OF THUNDER BAY
	Caring When You Need It Most

Part of the responsibility of being selected into the Simpler Times Network is allowing the families we have served the opportunity to tell Simpler Times how we are doing.

We encourage you to take a few moments to fill out this brief questionnaire. It is submitted directly to Simpler Times' home office.

If it is a positive comment they will share it with us. If we have failed in your expectation, Simpler Times will keep your name confidential, but discuss the nature of your complaint with us, in an effort to put a policy and process in place to ensure it does not happen again with future families.

Personal Information

Name:
Address:
City:	Postal Code:
Phone:
May we share your feedback with the funeral home? Yes No
May we publish your feedback on the Simpler Times Site?Yes No

Funeral Home Information

Name of Funeral Home:

Address:

City:

Postal Code:

Business Phone Number:

Name of Funeral Director:

Funeral Home Related Feedback

1. Why did you choose this particular funeral home? (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 this 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

Not Sure

4. Was the 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 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 this funeral home were reasonable." (Choose the one that applies)

I Agree

I Disagree

Not Sure

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

Yes

Not Sure

Simpler Times Related Feedback

1. Did you purchase a Simpler Times Funeral Arrangement Kit:

Yes No

1a. If you answered yes to 1., was the Arrangement Kit helpful in making the arrangements:

Yes No

1b. If you answered no to 1a., please give reasons:

2. Did you request Simpler Times product found on the selector:

Yes No

2a. If you answered Yes to question 2., please tell us what product(s) you chose:

Containers:

Urns:

3. If you purchased the Simpler Times Arrangement Kit, but did not purchase any other Simpler Times products, what factors influenced your decision:

Additional Comments or Suggestions



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