Preliminary Questionnaire

For best service, the more information you provide upfront ensures that you and your loved one's life story is properly and accurately chronicled. *please set aside approx. 30 minutes to complete*

Would you like to include a complimentary personalized opening? Foreward or Preface? If so, please write what you would like to say below:

Would you like a Dedication and/or Acknowledgement Page? If so, please write what you would like to say below:

1) Personal Info

Are there any assistive services that we can provide for the interview to accommodate any limitations, such as hearing or visual impairment?

How would you or your loved one (aka the Author/Interviewee) like to be addressed during the interview?

Full Name:

Birth Name:

Maiden Name:

Nicknames:

2) Family History

Parents Names:

Siblings Names:

Children's Names:

Grandchildren / Great Grandchildren: