Online Preplanning Form

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McKenzies Portage Funeral Chapel

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PLANNING AHEAD
ONLINE PREPLANNING FORM
PRE-PLANNING CHECKLIST
TALK OF A LIFETIME

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About You

Who is this plan for?

First Name

Middle Name

Last Name

Email Address

Phone Number

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Information

Full Legal Name

Address

Birth Date

Birth Place

Social Insurance #

Father's Name

Father's Birthplace

Mother's Name + Maiden name

Mother's Birth Place

Marital Status

Spouse's Name

Spouse's Maiden Name

Place of Marriage

Date of Marriage

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Work History

Occupation

Company Name

Years At Company

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Your Wishes

Visitation Options

Viewing at funeral home

Viewing elsewhere

No Visitation

Private

Public

Funeral Service Option

Service at funeral home

Service at church

Service at Cemetery

No Service

Reception Options

Reception at funeral home

Reception elsewhere

No Reception

Would you prefer burial or cremation?

Burial

Cremation

Final Disposition

Ground Interment (burial)

Columbarium (for cremation urns)

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Your Preferences

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

Please list any special themes you would like to include in your services.

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

Please list any specific foods or beverages you would like to make available to your family and guests at the services.

Please list any interests or hobbies you would like to include into your services.

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

Thank you for contacting us.
We will get back to you as soon as possible.

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