Riewerts Memorial Home, Inc.

Riewerts Memorial Home Services Feedback Form

At Riewerts Memorial Home we strive to be the best funeral service provider possible. In order to provide exceptional service we would greatly appreciate your feedback. By knowing what we are doing right and what needs improvement will allow us to keep providing the best services possible. We thank you in advance for your time.

* Required

Why did you choose Riewerts Memorial Home? *

Location
Religious Affiliation
Services pre-arranged
Facilities
Prices
Recommended by family/friend
Recommended by clergy
Funeral Home Staff
Previously served our family
Other:

Please rate the prices offered at Riewerts Memorial Home *

1 being the lowest and 7 being the highest

1 2 3 4 5 6 7
Very Unreasonable Very Reasonable

"During the arrangement process I felt well informed and received enough information to make my choices adequately." *

Respond to the statement with your choice from the list that best matches your response.

A growing trend is pre-planning and pre-financing their funerals. Would you be interested in receiving information on pre-planning and/or pre-financing a funeral for the future? *

Riewerts Memorial Home would be happy to provide this information to you.

Based on the service you received would you recommend Riewerts Memorial Home to others? *

"I felt very comfortable and satisfied with the staff and service level of the staff at Riewerts Memorial Home." *

Please rate your feelings on this statement with 1 being the lowest and 7 being the highest.

1 2 3 4 5 6 7
Agree Disagree

Please rate the following:

Choose only one per row

Satisfied Nuetral Dissatisfied Not Sure
Contact with the firm
Arrangement Process
Visitation
Appearance of facilities
Appearance of the deceased
Coordination of services

"Overall I was satisfied with the services provided by Riewerts Memorial Home." *

Please choose one from the list below.

Please feel free to leave any comments or concerns

Name:

E-mail Address:

I am a
Male
Female

Please select your age range
18-24
25-34
35-44
45-54
55-64
65+

Please list the city and state that you reside in.

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