Immediate Need

If a Death Has Just Occurred

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

If you want to talk to someone right now, please call us at 620-624-3844 day or night. We will answer any questions and talk you through the next steps which will likely include making arrangements to bring your friend or family member into our care and set a time for you and your family to come to the funeral home to begin the funeral arrangements.

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?

Call Us (620) 624-3844

Contact Us

Grief Support

365 DAYS OF GRIEF SUPPORT

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Immediate Need

If a Death Has Just Occurred

Immediate Need Form

Contact Us

365 DAYS OF GRIEF SUPPORT

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