Immediate Need

Immediate Need Form

Free Text

Personal Information of Deceased

Last Name*

Middle Name*

First Name*

Date of Birth*

Date of Death*

Time of Death*

Social Security Number*

Free Text

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?

Free Text

Physician Information

Name of Doctor Signing Death Certificate*

Email Address*

Business Telephone*

Street*

City*

State/Province*

Zip/Postcode*

Free Text

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?

(303) 440-3960

Greenwood & Myers Mortuary - Boulder Location

2969 Baseline Road

Boulder, CO 80303

FAX: (303) 440 3944

john@greenwoodmyersfuneral.com

mike@greenwoodmyersfuneral.com

(303) 833-3765

Greenwood & Myers Mortuary - Frederick Location

502 Walnut Street

Frederick, CO 80530

john@greenwoodmyersfuneral.com

mike@greenwoodmyersfuneral.com