At Need Information | Bella Vida Funeral Home

Immediate Needs

Your Information

Your First Name

Your Last Name

Your Email

Your Phone Number

Deceased's Information

First Name of Deceased

Middle Name of Deceased

New Field:

Death Date

Death Time

Authorization Person

Did the death occur from a disease declared by the Department of Health and Human Services to be infectious, contagious, communicable, or dangerous to the public health?

Yes

No

Check any that are present in body of the deceased:

Pacemaker

Defibrillator

Silicone Implants

Radioactive Implants (including "seeds")

Plastic cast(s)

All pacemakers, prostheses, plastic casts, and radioactive implants must be removed prior to delivering the deceased to the crematory.

Eventually the cremated remains will be interred or inurned in a cemetery or will be scattered:

Yes

No

Deceased will be transported to Bella Vida Funeral Home in the following type of container/casket:

A temporary container

An urn provided by the funeral

All pacemakers, prostheses, plastic casts, and radioactive implants must be removed prior to delivering the deceased to the crematory.

If the cremated remains are not being interred at the cemetery, then the staff at the crematory is requested by the authorizing person to make the following disposition of the cremated remains:

Ship by registered mail to

Address

Deliver by vehicle before

Date

Time

To funeral establishment to

Address

Would you like your loved one's obituary published on our website?

Yes

No (Additional fee will be added to your account)

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Immediate Needs

Immediate Needs

Pre-plan with us today.

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