Immediate Need

When a death has occured, we're here to help.

If you have experienced a loss, you do not have to navigate the next steps alone. Our caring staff is available any time of day or night to answer your questions, coordinate bringing your loved one into our care, and help you begin making arrangements.

Please call 765-644-6658 or your preferred chapel for immediate assistance. You do not need to complete this form before calling.

If you would like to share information before meeting with us, you may complete the optional form below. Provide what you know—our staff will help you with the remaining details.

For urgent assistance, please call rather than wait for a response to an online submission.

Immediate Need Form

Free Text

Personal Information of Deceased

Full Name*

Date of Birth*

Date of Death*

Time of Death*

Select a Funeral Home Location

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

Email Address*

Street*

State/Province*

Free Text

Personal Information of Person Legally Responsible for Disposition

First Name*

Last Name*

Relationship to Deceased*

City*

Zip/Postcode*

Phone Number*

Do You Have a Prearrangement on File with Us?

Immediate Need

When a death has occured, we're here to help.

Immediate Need Form

Quick Links

Bozell Funeral Homes & Crematory Locations

LAPEL CHAPEL

Lahm Chapel

Brown-Butz-Diedring CHAPEL

CONDO CHAPEL