Mobile Mortician of Texas

Tel: (432) 249-1333

mobilemortician@yahoo.com

Services

If a Death Has Just Occurred

First, let us express our deepest sympathy for your loss and know that we are here for you and your family during this difficult time.

If you've not done so, please call us at (432) 249-1333 day or night. We will make arrangements to bring your loved one into our care and will set a time for you and your family to either come to the funeral hall to begin the funeral arrangements or we can come to you.

If you would like, filling out the form below will help us gather the information we need to begin more quickly.

Immediate Need Form

Personal Information of Deceased

Personal Information of Deceased

Last Name*

Middle Name*

First Name*

Date of Birth*

Date of Death*

Time of Death*

Social Security Number*

Preparation Information

Preparation Information

Free Text

If Death Occurs Far From This Area Call Us and Not a Local Funeral Home, It Will Save You Money.

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?

Physician Information

Physician Information

Name of Doctor Signing Death Certificate*

Email Address*

Business Telephone*

Street*

City*

State/Province*

Zip/Postcode*

Free Text

Personal Information of Person Legally Responsible for Disposition

Last Name*

Middle Name*

First Name*

Relationship to Deceased*

Street*

City*

State/Province*

Zip/Postcode*

Primary Phone Number*

Secondary Phone Number*

Best Time to Reach Via Phone*

Do You Have a Prearrangement on File with Us?

If Yes, Under What Name?

Please Answer the following math Question.

CONTACT US

(432) 249-1333

mobilemortician@yahoo.com

43430 State Highway 17 South Fort Davis, TX 79734

Harris - Nadeau Mortuary Template - Official

365 DAYS OF GRIEF SUPPORT

Visit www.prepaidfunerals.texas.gov for information relating to the purchase of pre-need funeral contracts including descriptions of the trust and insurance funding options available under state law.

(432) 249-1333

Services

If a Death Has Just Occurred

Immediate Need Form

CONTACT US

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