Pre-planning Questionnaire

1. Introduction To End-of-Life Questionnaire

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There are two options for accessing this questionnaire.

1. Complete it online and receive a pdf summary of your answers. Please note that if you are unable to complete the questionnaire in one sitting and will need to return to it later, your computer must be configured to accept "cookies" and/or not delete them after each browsing session. Whenever you log on again, the "cookie" is needed to associate your computer with your questionnaire so that it can be retrieved for you to continue. If you can't accept or retain "cookies" on your computer, then you will have to either use Option #2 or submit it on online and complete it later using the pdf file you will receive from your online submission.

Your email address is needed for receipt of the report.

2. Download a black and white pdf file to your PC. Depending on the capability of your pdf reading software, you may be able to answer the questions directly on your computer. If not, then you can print the questionnaire and answer them on paper.

If you choose option #2, there are two sub-options:

a. Download the questionnaire from a link that will be sent via e-mail.

b. Receive the questionnaire as an attachment that will be sent via email.

You will receive the download link or the attachment within 48 hours after your request.

Question Title

* 1. Please enter your e-mail address below to receive the summary report described in Option #1, or the link or attachment described in Option #2.

Question Title

* 2. Which option do you prefer?

If you choose option "a" click "Next" below to begin answering the questions on the next page.
If you choose either option "b" or "c" click "Next" below and then "Submit Response" at the bottom of the next page.

a. Complete it online.

b. Download it from a link that will be sent to me by email.

c. Receive it as an attachment that will be sent to me by email.

Question Title

* 1. Please enter your e-mail address below to receive the summary report described in Option #1, or the link or attachment described in Option #2.

Question Title

* 2. Which option do you prefer?If you choose option "a" click "Next" below to begin answering the questions on the next page.If you choose either option "b" or "c" click "Next" below and then "Submit Response" at the bottom of the next page.

* 2. Which option do you prefer?

If you choose option "a" click "Next" below to begin answering the questions on the next page.
If you choose either option "b" or "c" click "Next" below and then "Submit Response" at the bottom of the next page.