Immediate Need

If A Death Has Just Occured

Need Immediate Assistance? Call Us Today.

Grand Rapids: 616-452-3006

Greenville: 616-754-5638

Immediate Need Form

Personal Information of Deceased

Personal Information of Deceased

Last Name*

Middle Name*

First Name*

Date of Birth*

Date of Death*

Time of Death*

Social Security Number*

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?

Physician Information

Name of Doctor Signing Death Certificate*

Email Address*

Business Telephone*

Street*

City*

State/Province*

Zip/Postcode*

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 Occured

Need Immediate Assistance? Call Us Today.

Immediate Need Form

Michigan Cremation & Funeral Care

Christiansen's Michigan Cremation & Funeral Care

A Year of Grief Support

Immediate Need

If A Death Has Just Occured

Need Immediate Assistance? Call Us Today.

Immediate Need Form

Michigan Cremation & Funeral Care

Christiansen's Michigan Cremation & Funeral Care

A Year of Grief Support

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