Name of Person Contacting The Natural FuneralPhoneEmailDying Person's NameAKA or nicknames - separated by commasBriefly, what are the current circumstances (hospice care etc, at home, facility?)Name of hospice if applicable:How can we help? Please briefly describe Immediate needs: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 dying person:Type of LocationResidenceHospiceERInpatientNursing HomeOtherOther Type of LocationPacemaker?YesNoUnknownPrimary Care PhysicianHospice ContactImmediate 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.YesNoUnknownCremation, burial or natural burial wish?Other TNF services possibly desired at this point:EmailSubmit
