Immediate Need

If A Death Has Just Occurred

We are so sorry for your loss and want you to know that we are here for you and your family.

When you're ready, please reach out to us, and we will help bring your loved one into our care and set up a time to begin making arrangements together.

If it’s helpful, you can fill out the form below to help us gather the necessary information to get started.

REACH OUT

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

Schmitt Funeral Home - WaKeeney

Schmitt Funeral Home - Quniter