Planning Ahead

Online Preplanning Form

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Personal Information

Who is this plan for?

First Name

Middle Name

Last Name

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About You

Email Address

Phone Number

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Family, Work, & Education

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Family Information

Father's Name

Father's Address

Mother's Name

Mother's Address

Marital Status

Spouse's Name

Spouse's Maiden Name

Place of Marriage

Date of Marriage

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Additional Family Members

Siblings (alive)

Siblings (deceased)

Children (alive)

Children (deceased)

Grandchildren (alive)

Grandchildren (deceased)

Great-Grandchildren (alive)

Great-Grandchildren (deceased)

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Education History

School Name

Highest Level of Education

School Location

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Work History

Occupation

Company Name

Years At Company

Did this person serve in the military?

Yes

No

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Your Wishes

Visitation Options

Visitation at funeral home

Visitation elsewhere

No Visitation

Funeral Service Option

Funeral service at funeral home

Funeral service elsewhere

No Funeral Service

Reception Options

Reception at funeral home

Reception elsewhere

No Reception

Would you prefer burial or cremation?

Burial

Cremation

Final Disposition

Ground Interment (burial)

Mausoleum Entombment (above ground burial)

Columbarium (for cremation urns)

Ashes returned to family

Would you prefer to include a graveside/committal service?

Yes

No

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Your Preferences

Please list any musical selections you would like to include in your services.

Please list any special themes you would like to include in your services.

Please list any poems, religious texts, or readings you would like to be read at your services.

Please list any specific foods or beverages you would like to make available to your family and guests at the services.

Please list any interests or hobbies you would like to include into your services.

Is there a special story, personal thank you, or message of hope you would like to be read during your services?

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 done so, please call us at 608-296-2272 day or night. We will make arrangements to bring your loved one into our care and will set a time for you and your family to come to the funeral home to begin the funeral arrangements

If you would like, filling out the form below will help us gather the information we need to begin more quickly.

Immediate Need Form

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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

No

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

Yes

No

Has the Body Been Released for Removal?

Yes

No

Do You Permit Us to Cremate the Body?

Yes

No

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?

Planning Ahead

Online Preplanning Form

Online Preplanning Form

If a Death Has Just Occurred

Immediate Need Form

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