Immediate Need

If A Death Has Just Occurred

First and foremost, please accept our heartfelt condolences for your loss. We want you to know that we’re here for you and your family every step of the way during this difficult time.

Please call us anytime, day or night. We’ll make arrangements to bring your loved one into our care and schedule a time for you and your family to meet with us to begin planning the funeral.

Immediate Need Form

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PERSONAL INFORMATION OF THE DECEASED

First Name*

Middle Name*

Last 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?

Do you permit us to embalm the body?

Has the Body Been Released for Removal?

Do You Permit Us to Cremate the Body?

If Yes, Who Has Granted Permission?

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PHYSICIAN INFORMATION

Name of Doctor Signing Death Certificate*

Email Address*

Business Telephone*

Street Address*

City*

State*

Zip Code*

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PERSONAL INFORMATION OF PERSON LEGALLY RESPONSIBLE FOR DISPOSITION

First Name*

Middle Name*

Last Name*

Relationship to Deceased*

Street Address*

City*

State*

Zip Code*

Primary Phone Number*

Secondary Phone Number

Best Time to Reach Via Phone*

Do you have arrangements on file with us?

If Yes, Under What Name?

CALL ANYTIME

If A Death Has Just Occurred

Immediate Need Form

Mora Location

Sandstone Location

Hinckley Location

Isle Location