Immediate Need

If a Death Has Just Occurred

First, let us express our deepest sympathy for your loss and know that we are here for you and your family during this difficult time.

If you've not done so, please call us at (580) 852-3212 day or night. We will make arrangements to bring your loved one into our care and will set a time for you and your family to come to the funeral home to begin the funeral arrangements.

If you would like, filling out the form below will help us gather the information we need to begin more quickly.

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?

Slide title

Write your caption here

Button

Slide title

Write your caption here

Button

Helena Location
309 E. 4th Street
Helena, OK 73741
Tel: 1-580-852-3212

Cherokee Location
1305 S. Grand Ave
Cherokee, OK 73728
Tel: 580-596-2002

Okeene Location
209 N. Main Street
Okeene, OK 73763
Tel: 580-822-3303

Kiowa Location
204 N. 7th Street
Kiowa, KS 67070
Tel: 620-825-4936

Medford Location
108 W. Cherokee St.
Medford, OK 73759
Tel: 580-395-2323

IMMEDIATE NEED

If a Death Has Just Occurred

Immediate Need Form

Slide title

Slide title