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The Benefits of Pre-Planning

Please fill in your answers to the questions below and click Submit at the bottom.

Funeral Pre-Planning

Information for whom you are planning:

First Name:

Middle Name:

Last Name:

Gender:
Male
Female

Your relationship to this person:

Your Contact Information:

Your Name:

Best Phone to Contact:

Best Time to Contact:

E-Mail Address:

Biographical Information for whom you are planning:

Birth Date:

Birth Place:

Marital Status:
Married
Single
Widowed
Divorced

Father's Name:

Address if living:

Mothers's Name:

Address if living:

Living Siblings:

Deceased Siblings:

Living Children:

Deceased Children:

Living Grandchildren:

Deceased Grandchildren:

Living Great Grandchildren:

Deceased Great Grandchildren:

Education:

Highest Level of Education:

Graduate Of:

Secondary School:

Technical School:

College:

Graduate School:

Work:

Occupation(s):

Company(ies):

Military:

Branch and Years:

 

Funeral Plan

Visitation:

Funeral Service:

Reception:

Disposition:

Do you wish a graveside/committal service?:
Yes
No

Final Disposition:

Other Considerations:

List Casket Bearers:

Flower Preferences:

List any clothing, jewelry, glasses you would like to include if open casket viewings:

Please list any musical selections you would like to include in your services:

Please list any poems, religious passages, or readings you would like to be read at your services:

List any interest or hobbies you would like to include into your services:

Describe any special themes you would like to include into your services:

List any specific foods or beverages you would like to have as part of your services:

Is there any special story, personal thank you, or message of hope you would like to be read during your services?:

List any Memorials or Charities that you would like cited for donations.:

Thank you for taking the time to think about your final arrangements. It is a fact of life that we all must face, and sharing this information will help your loved ones at a difficult time in the future.

We will contact you to confirm receipt of this information. If you wish to further discuss the details of your arrangements, we will be happy to call or meet with you.



Free Funeral pre-planning survey

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Washington Memorial Funeral Home
4 Washington Avenue
North Haven, CT