Memory Gardens of Amarillo
Questionnaire

Funeral Cost Questionnaire

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We need your help...In an effort to control the rising cost in the funeral industry, we would appreciate your input on this questionnaire. Our aim is to meet the needs of our community and provide local market information on the flexible choices of both traditional and cremation funeral care. These questions are extremely important and we appreciate your help.

1.Have you ever been responsible for making funeral arrangements for a loved one:


2. If yes, did you choose the funeral home because:


3. Do you own cemetery property?:


4. Is Advanced Funeral Planning something that (please select all that apply:

You have heard about?               	You have considered?                
You have thought about? You would like to know more about?
Other                               

5. Do you know that Funeral Planning can:

           5a. Protect against cost of tomorrow's funerals?

  5b. Help you qualify for Medicaid for federal assistance benefits?

7.Are you interested in recording your family history and vital information?


8. How much would you expect to pay for a funeral?

9. What is your age group?:


10. What is your current employment status?

Thank You For Your Cooperation!

In appreciation, we would like to offer you the opportunity to complete your own Family Record Guide. This unique booklet contains your wishes for your funeral arrangements. Just mark the box to receive your free guide.

Yes! Please make sure I get my free guide so I can make my wishes known.

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Revised: 10/03/05