Immediate Need

If a Death Has Just Occurred

First, let us express our deepest sympathy for your loss and know that we are here for you and your family during this difficult time.

If you've not already done so, please call us at (330) 539-5955 - day or night. We will make arrangements to bring your loved one into our care and will schedule a time for you and your family to meet with us and begin making funeral arrangements.

If you wish, you may also fill out the form below - this will help us gather the necessary information in advance and allow us to assist you more efficiently.

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*

Free Text

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?

Free Text

Physician Information

Name of Doctor Signing Death Certificate*

Email Address*

Business Telephone*

Street*

City*

State/Province*

Zip/Postcode*

Free Text

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?

Immediate Need

If a Death Has Just Occurred

Immediate Need Form

A Year of Grief Support