Survey Form

Online Tributes

Comment & Suggestions

Survey Form

Surveys can assist us greatly in understanding the needs and views from the community. We do appreciate and value all of your feedback. The information we gather is used to help us to improve on service. George Darte Funeral Home is constantly adapting to the specific needs of the community.

Personal Information

Name:
Address:
City:
Province / State:
Postal / Zip Code:
Phone Number:

You are?	Married Single Widowed
Your age?
Do you have Children?	Yes No
If so, How many Children?
Employment Status?	Working Retired
Survey Information

Do you have a Will?

Yes No

Has it been updated lately?

Yes No

Have you ever made funeral arrangements before?

Yes No

If 'Yes':

Within the Past Year 1 to 3 Years Over 3 Years

How much do you think funerals cost?

$500 - $999	$1,000 - $1,999	$2,000 - $3,999
$4,000 - $5,999	$6,000 - $8,500	Over $8,500

Have you been informed that Pre-Arranged and Funded funeral plans exist?

Yes No

Do you have a pre-paid funeral plan?

Yes No

If "No", have you ever considered a prepaid funeral plan?

Yes No

Have you purchased Life Insurance to help pay for your funeral arrangements?

Yes No

If "Yes", does the beneficiary understand the policy and the reason for having this policy?

Yes No

When choosing your arrangements, would you choose?

Burial Cremation Mausoleum Entombment Not Sure

Have you purchased cemetery property?

Yes No

In the event of your death, who will be responsible for making your funeral arrangements?

Spouse Children Other family member Other

Who will be responsible for making the payment of your arrangements?

Spouse Children Other family member Other

Does the person making the arrangements know of all your preferences, including casket, flowers and services?

Yes No

Would making your own arrangements give you peace of mind knowing that you have planned and paid for your own funeral arrangements?

Yes No

Do you feel that making your own funeral arrangements are as important as keeping your life insurance and will up to date?

Yes No

If you have any further comments or questions that we help us then please use the box that we have provided below: