Push button for menu

Home
Obituaries
About Us
Locations
- Roan Family Funeral Home
- Roan Family Funeral Home - Still Oaks Chapel
Pre-Plan
Veterans
Resources
Merchandise
Cremation
Payments

">1-781-290-3675

Push button for menu

Home
Obituaries
About Us
Locations
- Roan Family Funeral Home
- Roan Family Funeral Home - Still Oaks Chapel
Pre-Plan
Veterans
Resources
Merchandise
Cremation
Payments

Pre-Arrangements Form

In this section

Pre-Arrangements

NH Medicaid Spend Down

The Talk of a Lifetime

Use this form to provide us with as much or as little detail as you wish. At a minimum, provide us with your name and telephone number and tell us how you'd like us to work with you on the remaining information using the options at the base of the form.

Pre-Arrangement Details

Personal Information On Individual Being Pre-Arranged

Full Name of Individual Being Pre-Arranged

Street

City

State/Province

ZIP/Postcode

Funeral Home

Your Name & Relationship to Individual Being Pre-Arranged

Date of Birth

SSN #

Your Phone # & Email Address

Place of Birth

Father's Name

Mother's Name

Mother's Maiden Name

Marital Status

Spouse's Name

Spouse's Maiden Name

Additional Family MembersPlease use the area above to enter the names of siblings, children and grandchildren.

Work/Education History

Education Level

Grade SchoolHigh SchoolDegreeMasters DegreeDoctorate

Occupation

Last Employer

Kind of Business/Industry

Military Record

Did you serve in the military?

YesNo

Branch of Service

Date Entered Service

Date Discharged

Service Number

Rank at Discharge

Do you have a copy of your discharge papers?

YesNo

Next-Of-Kin

Next-Of-Kin Address

Next-Of-Kin Telephone

Funeral Service Request

Place of Service

Place of Visitation

Religious Denomination

Place of Worship

Lodge/Union/Assoc. Membership

Disposition Request

I Prefer

Cemetery

Lot #(if applicable)

Section/Letter(if applicable)

Grave #(if applicable)

Cemetery Address

I have made a last will and testament

YesNo

Summary Details

Additional instructions for us

Memorial requests or donations to charity

Please select from one of the options below:

Send me information about pre-arrangements

Contact me to set up an appointment

No appointment needed just keep my request and information on file

Anti-Spam Security Question

Contact Us

We are available 24/7, 365 days a year.

If you need our services immediately, please call us.
We will begin the process of bringing your loved one into our care right away.

Our support in your time of need does not end after the funeral services. Enter your email below to receive a grief support message from us each day for a year. You can unsubscribe at any time.