"Of all the ways we can express love, one of the most thoughtful involves funeral planning before the need arises. By taking the necessary steps now, you can spare those you love unnecessary hardship later"

By filling out this survey, you have taken the first steps in relieving your loved ones the burden of dealing with funeral arrangements during the time of loss. We are here to help.

Most of us plan for the possible; the potential misfortunes of life that seldom actually happen. Yet, few of us prepare for the inevitable.  This funeral planning survey was developed to help families plan and fund funerals before the need arises.

If a death occurs, I don’t want your family to have the worst experience of their lives – burdened with making funeral arrangements. We want to help by pre-arranging your wishes.

To help with this, we’re conducting a survey to make your wishes known. It helps us gain a better understanding of our community’s expectations. This survey will provide information that allows us to give the service you expect and helps us remain a resource to families like yours.

This survey will be treated with confidentiality. Please fill out the questionnaire and return it. A $50 gift card good to local pre-selected businesses is offered as a complimentary gift for those signing a pre-arrangement plan.

Thank you,

Brad Bytnar, Owner 

Home Phone:

Best time to call:

E-mail address:

1. Are you  Married  Single  Widowed

2. How old are you?  Under 40  41-55  56-70  71 or older

3. Have you ever been responsible for making funeral arrangements for someone else?
Yes  No

If yes, was it ?  Within the last year  Within the last two years  Over two years ago

4. Are you aware that you can arrange and pay for a funeral in advance of need? 
Yes  No

5. Do you have a prepaid funeral plan?  Yes  No

6. Do you own cemetery property?  Yes  No

7. Are your loved ones aware of your preferences in funeral arrangements?  Yes  No

8. Which of the following would you choose for yourself?
Above ground burial Below ground burial  Cremation

9. Do you have up-to-date biographical information and accurate records to help a loved one with your funeral planner?  Yes  No

10. In the event of your death, who is responsible for making your final funeral arrangements?
 Spouse  Son/Daughter  Other:
Name:

11. Does this person know your preferences including type of casket, music, flowers
and services?  Yes  No

12. As part of our community service program, we offer the following services. Would you like to receive information on any of the following:
 Funeral Cost Analysis
 Affordable Payment Plans
 Cremation Options
 Veteran’s Benefits
 Social Security Benefits
 Insurance Policy Assignments
 Protecting Your Assets while applying for Nursing Home assistance

All information will be kept strictly confidential and used only to help us better service the families of our community.

If this survey reaches you at a time of illness or loss, please accept our sincerest apologies.