This survey will be used to help parents make informed choices about the funeral home they select for their baby.  Please provide your contact information so parents may contact you.  

Thank you for participating and for caring about families who have lost a baby to stillbirth.  Please make sure this information is updated annually.

Funeral Home:
Name and title:
Do you provide funeral services for infants and/or little miscarried babies?
Please Explain.
Will you work with a hospital to help the parent have their baby at home for a period of time, if they wish, under your direction?  (This requires appropriate forms, offering to let the family drive their own baby home, making sure the baby gets back to your funeral home, ect.)
Please Explain.
Do you encourage both parents to discuss the services you offer and what they wish to do rather than working with a family member or only one parent?
Please Explain.
Do you provide an opportunity for the family to dress, see, hold, ect. the baby prior to the service?
Do you encourage the family to do this and tell them why?
Do you have a rocking char available?
Do you provide literature and/or direction to assists in writing an obituary and planning the service that is rocking char available?
Do you provide the family private time with the baby? (including other children)
Do you take pictures and/or encourage the family to take pictures/videos of their baby?
How long after you receive the baby's body do you want/need to have the service?
Do you encourage the family to have a viewing time to help make the baby real for the rest of the family who may not have met her/him?
Do you allow/encourage families to have the service in there home, at their church, as well as in your funeral home chapel?
Do you work through or with any particular cemetery?
Are there any other comments you want included about your Funeral Home or the services you provide?
What options are available for infant funerals and what are the price ranges?
under 20 weeks gestational?    over 20 weeks?
Do you provide free or relatively inexpensive services for infants if parents have financial hardship?
List your prices for this year.
Please note: It is understood that your prices my be approximate for this year.  Please attempt to update this survey annually.  This will help us keep your page up to date. Thank you.
This survey for was create by Sherokee Ilse and Suson Martenex Erling. ©1982/2008
Survey available through Wintergreen Press, Inc.