BackInHisHands LLC

Pre-Screening Questions

1). 1 old testament scripture/1 new testament scripture for each person. This will be for program

2). Two songs each for your funeral/memorial. Optional-A song for processional and recessional

3). Name, address & Phone# of Person or persons to gain legal custody of your minor children upon your death.

4). If you would like to write a poem to your family, have it ready, or email it to me, otherwise you can pick from my list of poems.

5). Name of at least 2 people to make healthcare decisions on your behalf, in case you can’t. Your DNR orders- (do not resuscitate)?

6). List of allergies and drug sensitivities if applicable. Blood type?

7). Name of primary care physician, address, and phone#. Same for minor children.

8). List all medications you currently take, directions, pharmacy name & phone#.

9). Would you like to be an organ donor? yes/no

10). Name, address, & phone number of person to handle your estate.

11). Be ready to provide name of funeral home, burial site, and your wishes for the disposition of your body.

12). If insured, name of insurance company, phone#, & policy# of all policies that apply.

13). Do you have a will or trust? If so, bring or email me copies. If not, would you like a will done?

14). Do you have a military background? If so, which branch of service, DD214#? Do you want a military funeral?

15). Do you want a funeral or memorial service? With or without your body? If with body, open or closed casket? Do you want a viewing?

16). Your name, address, Phone number and email.