Survey Questions
 

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If you would like this form in a PDF file click here!

Power Survey

Compliments of:
Kubasak Associates

531 Calais Drive, Mesquite, NV 89027-8825 Phone: (702) 345-3212

 

What is one thing that you would have liked to have done that was not done?

What is the most memorable thing you remember about our services?

Our personnel?

Which one member of our staff stands out in your mind? Please tell us why?

What is the most memorable thing you recall about how our telephones were answered?

What is the most memorable thing you recall when you arrived at the funeral home to make arrangements?

Was there anything that happened – or was said – that gives you the feeling that someone on our staff really ‘cared’ for your feelings?

Were any words or phrases used that you did not fully understand?

Did anything occur that made you feel uncomfortable?

If you could teach our staff one thing, what would it be?

If you could change our funeral home, what one thing would you start with?

What, if anything, might we have done to make things easier for you:

bulletDuring our first conversation with you on the telephone?
bulletDuring the arrangement conference?
bulletDuring the visitation?
bulletWith our transportation?
bulletDuring the funeral ceremony itself?
bulletAfter the funeral?
bulletAt the cemetery?

What is the primary factor that caused you to choose us?

What is one thing that will cause you to recommend us to others?

____ Check here if nothing memorable happened.

Optional: Your name: _________________________________________

Telephone #: __________________ Best time to call: _________

 

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Kubasak Associates

Michael W. Kubasak
Kubasak Associates
531 Calais Drive, Mesquite, NV 89027-8825
Phone: (702) 345-3212

E-Mail: mike@kubasak.com