ONLINE PRE-PLANNING FORM

Planning ahead is about making your wishes known in advance. The first step would be to write down your wishes. Indicate if you would prefer burial or cremation. Write down your ideas for the service you would like. Then consider visiting with your family to get their input.

You may want to visit our cemetery and take in the feel for it. We are here to help answer your questions so you can make an informed decision that gives you comfort.

To help, we created this simple online form. Fill out as much or as little as you wish, but we do need your basic contact information and a bit about yourself so we can follow up with you to get any additional information we may need to formulate a recommendation and cost. If you have given this any thought to burial plans, let us know your current thinking. This too will help us put together a better plan for you.

All the information you provide us is strictly confidential.

If you have any questions, or would like assistance with this form, please call (210) 992-2143.

Online Pre-Planning Form

Who is this Plan for? *

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First Name *

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Last Name *

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Health History *

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Are you currently on oxygen, hospitalized, receiving hospice care, or residing in a nursing home, long-term or residential care facility, or group home; or during the past two years have you been advised by a medical professional to have any surgical procedure that has not been performed; or have you been treated or are you being treated (including medication) by a medical professional for any of the following diseases or disorders: Congestive Heart Failure Immune System Disorder Chronic Obstructive Pulmonary (lung) Disease Amputation (caused by disease) Heart Disease Cirrhosis of the Liver, Emphysema, Alzheimer’s/Dementia Stroke Drug or Alcohol Dependency Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease) Cancer (other than skin) Kidney failure (including dialysis) Diabetic Coma/Insulin Shock

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Explanation of Health

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Age *

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Are You a Veteran *

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Current Preference

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e-Mail *

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Address *

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City *

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Zip Code *

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Phone Number (optional)

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Tells us a bit about yourself. *

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What are your current thoughts about burial plans?

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