Below is the intake form to fill out to request information regarding pre-planning or if a death has occurred. You may complete this form for yourself or for a family member. At a minimum, please provide us with your name and telephone number and tell us how you'd like us to work with you using the options at the bottom of the form. This form provides the ability to answer many of the questions that will be asked during your appointment in advance and provides the necessary information for completing the death certificate.