Immediate Need Funeral Services in Lancaster, OH

If A Death Has Just Occurred

Immediate Need Form

Free Text

PERSONAL INFORMATION OF THE DECEASED

First Name*

Middle Name*

Last Name*

Date of Birth*

Date of Death*

Time of Death

Social Security Number*

Free Text

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?

Free Text

PREPARATION INFORMATION

Name of Doctor Signing Death Certificate*

Email Address*

Business Telephone*

Street Address*

City*

State*

Zip Code*

Free Text

PREPARATION INFORMATION

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?

Get in Touch

740.386.3725

thellerfuneralservice@gmail.com

Immediate Need

If A Death Has Just Occurred

Immediate Need Form

A Year of Grief Support