Information Form

This is the information we require that allows us to fill out all of the necessary documentation for you. You may communicate this information to our staff over the phone or if you prefer, you can enter the information below.

Please do not be concerned if you only have some of the information.  Please fill out as much of the form as you can and any missing information can be submitted at a later time through this form or communicated to our staff over the phone.

Informant's Information

Please enter the information of the person filling out this form.

Relationship to Deceased
First name
Middle name
Last name
Street Address
City
Postal Code
Phone
E-mail

Next of Kin/Executor Information

Is there a will?	Yes No Unsure
In order to make final arrangements we will require the executor’s participation and permission. If there is no will in place, the legal next of kin will be required to participate in the arrangements. Please enter the information of the executor or, if there is no will, the information of the legal next of kin.
If you, the informant, are the executor or next of kin
Relationship to Deceased
First name
Middle name
Last name
Street Address
City
Postal Code
Phone
E-mail

Deceased's Information

Location of Deceased
First name
Middle name
Last name
Street Address
City
Postal Code
SIN
Date of Birth
City of Birth, Province
Marital Status	-- Please select -- Single Married Widowed Divorced Common-Law Same-Sex Partner
Spouse (maiden name)
Occupation for most of working life
Industry
Father's Name (Last, First)
Father's Place of Birth (City, Province)
Mother's Maiden Name (Last, First)
Mother's Place of Birth (City, Province)

Safety Information

Is there a pacemaker or defibrillator present?	Yes No Unsure
Permission granted to remove said device?	Yes No
Was death due to infectious, or contagious disease?	Yes No
If yes, pleace specify

Services

Cremation Burial Undecided
Would you like more information, or to have us organize, one of the following services?	I do not wish to organize a service 1 hour family gathering more info A family gathering of up to 25 attendees and held at any of our pre-designated locations with an urn present. Flowers, catering, and other services can be arranged. Memorial Service more info A 2 hour visitation incorporating a brief formal or ritual service if desired with an urn present. Our staff can arrange for everything, including flowers and catering if desired. Visitation and Reception more info A 2 hour visitation followed by a service and ceremony. Families also have the option of a graveside service after the ceremony as well as a reception if necessary. Identification more info Being able to see a loved one before a final disposition is helpful for a sense of closure. This is not necessarily a funeral service, but an opportunity to briefly say goodbye for before final disposition. Witnessing of cremation more info Witnessing of a cremation is a service where families wish to witness the actual cremation process. This is a very common request since this type of brief ceremony provides families and friends with a feeling of closure.
Would you like to purchase an urn?	Yes No
If yes, what type of urn would you like?
Would you like help settling your estate?	Yes No
Are there any additional services you are considering?	Yes No
If yes, pleace specify
Additional Notes
How did you find out about our services?	-- Please select -- Internet Brochure Friend or Family Referral Hospital or Nursing Home Referral Yellow Pages Subway Billboard
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