Family Service Questionnaire What influenced you to choose our funeral home?   Previous Service   Advertising   Reputation   Friends   Convienent Location   Clergy   Attractive Facilities   Recommendation   Other - Specify The funeral director making arrangements was:   Responsive   Impatient   Helpful   Knowledgeable   Confusing   Caring Your concerns about making funeral arrangements, if any, could be contributed to:   Coping with the shock of loss   Potential expense   Choosing the appropriate casket, service, etc.   Not knowing what to expect   Other - Specify Please indicate your impression of the following:   Excellent Acceptable Unacceptable Choices of funeral service & merchandise:  Attention to detail:  Individual service:  Range of prices:  Sensitivity of funeral director:  Flexibility of staff to meet your needs:  Overall satisfaction:  The price of the funeral that you selected was:   Less than expected   About what we expected to pay   More than expected Would you recommend our funeral home to others?   Yes   No Do you think that making funeral arrangements ahead of time is a good idea?   Yes   No Please share any other comments or suggestions you may have: Security Code:

Sears - Middleton - Jones Funeral Home, Inc. 209 North Main Street North Syracuse, NY 13212 315-458-0490 E-mail: info@searsmiddletonjones.com

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