Immediate Need

Immediate Need Form

Free Text

Personal Information of Deceased

Last Name*

Middle Name

First Name*

Date of Birth*

Date of Death*

Time of Death

Social Security Number

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Preparation Information

Has a Doctor / Coroner Been Notified?

Yes

If Deceased Passed at Home, Do You Permit Us to Embalm the Body?

Yes

Has the Body Been Released for Removal?

Yes

Do You Permit Us to Cremate the Body?

Yes

If Yes, Who Has Granted Permission?

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Physician Information

Name of Doctor Signing Death Certificate*

Email Address*

Business Telephone*

Street*

City*

State/Province*

Zip/Postcode*

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Personal Information of Person Legally Responsible for Disposition

Last Name*

Middle Name*

First Name*

Relationship to Deceased*

Street*

City*

State/Province*

Zip/Postcode*

Primary Phone Number*

Secondary Phone Number*

Best Time to Reach Via Phone*

Do You Have a Prearrangement on File with Us?

If Yes, Under What Name?

Helpful Information for when we meet

When you meet with a member of our staff to discuss your arrangements, we'll first provide you with a general price list to give you a basic idea of what our services cost.

We'll then ask you about your loved one to gain an understanding of the person the services will honor. Use this time to communicate your ideas and preferences, share your loved one's life story, revisit memories, and highlight their accomplishments. Our professionals will use this information to guide you in the creation of a personalized, meaningful celebration of your loved one's life.

This process may include:

Preparing and filing the official Death Certificate
Scheduling the services and events (including the location, date, and time)
Selecting a casket, urn, or other products you may need
Drafting an obituary
Selecting pallbearers

We'd like to make this process as smooth and stress-free for you as we can, so remember to bring the following information about your loved one with you as well:

Full legal name and home address
Social security number
Date of birth
Place of birth
Father's name
Mother's maiden name
Veteran's discharge papers (DD-214), if applicable
Highest education
Occupation
Information about the burial location, if applicable
Clergy name and phone number, if applicable
Names and relationships of survivors
Insurance policy information if using to pay for funeral expenses

Please also bring a recent photograph and any clothing you'd like us to use when dressing your loved one for the service.

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Immediate Need Form

Helpful Information for when we meet

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