Name of Person Contacting The Natural Funeral

Phone

Email

Decedent's Name

AKA or nicknames - separated by commas

Decedent's Gender

Briefly, what are the current circumstances (hospice care etc, at home, facility?)

Name of hospice if applicable:

How can we help? What are your immediate needs? Please give us a brief overview of your wishes. We can discuss all your options at an in-person meeting.

Cremation, burial or natural burial wish?

Are you interested in our Reverent Body Preparation (with natural care products and essential oils) or a vigil?

Please tell us briefly about any spiritual/religious beliefs, or other personal values we should be aware of:

Let us know a time/times you are available to meet with a Natural Funeral director to create an after-death care plan. Please provide an address and preferred time for meeting?

Current location of the deceased:

Specials details of access for removal of decedent’s body: stairs, elevator, etc.

Have the authorities/coroner been notified? (If the patient was not on hospice.)

Yes
No
Unknown

Has the pronouncement of death occurred?

Yes
No
Unknown

Type of Location

Other Type of Location

Pacemaker?

Yes
No
Unknown

Primary Care Physician

Hospice Contact

Immediate next of kin who should be included in any planning meeting:

List any good friends you would like to attend the meeting.

Is there a Designated Agent?

Is there a Designated Agent form? Especially important for cremation.

Yes
No
Unknown

Other TNF services possibly desired at this point:

TNF At-Death Intake Form

The Natural Funeral