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Pre-planning Survey

Please complete this form to the best of your ability. If you have questions prior to our contacting you please call 717-394-4097 and mention that you are completing pre-arrangements online.

Today's Date
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1) Have you ever attended a funeral at or visited one of our facilities?
- Yes
- No
2) Have you ever been responsible for making funeral or cremation arrangements?
- Yes
- No
Which is most important to you in selecting a funeral home?
- Location
- Reputation
- Price only
- Quality of service
Is anyone in your household a veteran?
- Yes
- No
Which of the following would you most likely choose for yourself?
- Burial
- Cremation
- Body Donation
Have you made firm plans and arrangements for cemetery property?
- Yes
- No
Are you aware that prearrangements can be transferred from one funeral home to another?
- Yes
- No
If paying for the funeral, which of the following would you use?
- Life insurance
- Savings
- Family members
- Unknown
Would it give you peace of mind to know you could do the planning in advance and that your family would not have to make arrangements in a time of grief?
- Yes
- No
Would you like to have more information about your choices and options in regards to planning a funeral or cremation service?
- Yes
- No
Name*
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Cell Phone (if applicable)
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