To Families in Our Community:

I need your help. Our firm is conducting a survey to determine how members of our community plan for one of the hardest events a family faces…the death of a loved one. The questions that follow are designed to help us understand what people want and need at this most difficult time.Your answers will help us improve our service by understanding what is most important to you. Please take a moment and fill out the 15-question survey below; as a token of our appreciation, we will send you a free Funeral Planning Guide. Thank you so much for taking the time to complete this survey. We appreciate your assistance.

Sincerely,
Buddy Phaneuf
President

Community Advance Planning Survey

1. What is your age group?
- Under 50
- 50 - 60
- 61 - 70
- 71 - 80
- Over 80
2. In the event of a death in the family, what would influence your choice of a funeral home?
Check all that apply.
- Previous experience
- Location
- Price
- Reputation
- Services offered
- On-site crematory
- Religious affiliation
- Other
Please specify
3. Have you ever had to make funeral arrangements for a loved one?
- Yes
- No
When?
- Within the last 12 months
- 12-24 months ago
- Over 2 years ago
4. Which of the following would you choose for yourself?
- Ground burial
- Cremation
- Body donation
- Unsure
5. Whether choosing burial or cremation, which of the following funeral services would you choose for yourself?
- Traditional (visitation and funeral ceremony)
- Limited service with same day visitation
- Basic burial with no visitation
- Cremation with memorial service
6. Do you have up-to-date biographical information and accurate records to help a loved one with your estate, funeral or cremation planning?
- Yes
- No
7. In the event of your death, who is responsible for making your funeral arrangements?
- Spouse
- Children
- Family member
- Friend
- Unsure
8. Does this person know what type of final arrangements you prefer?
- Yes
- No
- Unsure
9. Are you aware that you can arrange and pay for final arrangements in advance of need?
- Yes
- No
10. Is there a military veteran in your household?
- Yes
- No
11. How much might you expect to pay for your final arrangements?
- Under $2,000
- $2,000-$4,000
- $4,000-$7,000
- $7,000-$9,000
- $9,000-$11,000
- $11,000 +
- Unsure
12. If you have not made advance arrangements, how will your family most likely expect to pay for your final expenses?
- Savings
- Insurance policy
- State/City assistance
- Bank loan
- Borrow from family or friends
- Unsure
13. Did you know that by prefunding your arrangements now, you can:
Guarantee your final wishes will be fulfilled?
- Yes
- No
Create a payment plan to meet your budget?
- Yes
- No
Protect your savings from Medicaid?
- Yes
- No
Lock in your services at today’s lower prices?
- Yes
- No
14. If your loved ones would have to plan your funeral tomorrow, what would concern you the most?
- The emotional burden on survivors
- No one would know what I wanted
- The financial strain/emotional overspending
- The potential for disagreement/conflict among my survivors over what to do
- I had not taken care of it ahead of time
15. Please send me free information on the following checked items:
- The Funeral and Cremation Planning Guide
- Veterans benefits
- Social Security benefits information
- Cremation options
- Nationwide Travel Protection
- Funeral options
- Payment Plans
- FREE Cost Estimate
Thank you for your help. Please share your name, address and phone so we can provide you a complimentary gift...a Funeral Planning Guide as our way of saying thank you for completing our survey. We will contact you with any of the other information that you requested and to answer any questions.
Name
First Last
Address
Street Address City State / Province / Region ZIP / Postal Code
Phone
Best Time to Call
Email
Please sign me up for your free e-newsletter.
- Yes
- No
Name
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