Immediate Need

If A Death Has Just Occurred

First and foremost, please accept our heartfelt condolences for your loss. We want you to know that we’re here for you and your family every step of the way during this difficult time.

If you haven’t already, please Contact Us anytime, day or night. We’ll make arrangements to bring your loved one into our care and schedule a time for you and your family to meet with us to begin planning the funeral.

To help us get started more efficiently, you’re welcome to fill out the form below. It will allow us to begin gathering the necessary information ahead of your visit.

Immediate Need Form

Free Text

PERSONAL INFORMATION OF THE DECEASED

First Name*

Middle Name*

Last Name*

Date of Birth*

Date of Death*

Time of Death

Social Security Number*

Free Text

PREPARATION INFORMATION

Has a Doctor / Coroner Been Notified?

Do you permit us to embalm the body?

Has the Body Been Released for Removal?

Do You Permit Us to Cremate the Body?

If Yes, Who Has Granted Permission?

Free Text

PHYSICIAN INFORMATION

Name of Doctor Signing Death Certificate*

Email Address*

Business Telephone*

Street Address*

City*

State*

Zip Code*

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PERSONAL INFORMATION OF PERSON LEGALLY RESPONSIBLE FOR DISPOSITION

First Name*

Middle Name*

Last Name*

Relationship to Deceased*

Street Address*

City*

State*

Zip Code*

Primary Phone Number*

Secondary Phone Number

Best Time to Reach Via Phone*

Do you have arrangements on file with us?

If Yes, Under What Name?

If A Death Has Just Occurred

Immediate Need Form

Smits Funeral Home

Smits DeYoung-Vroegh Chapel

Smits-Steger Memorial Chapel