HOME
ABOUT US
OBITUARIES
SERVICES
URN STORE
Cemetery
PLANNING AHEAD
GRIEF SUPPORT
RESOURCES

Call Now Available 24/7 (205) 322-05 43

For Assistance, Call Now 205-322-0543

Send Flowers

ABOUT US
OBITUARIES
SERVICES
URN STORE

PLAN AHEAD
GRIEF
RESOURCES

Online Preplanning Form

The staff of Jefferson Memorial Funeral Home and Gardens has the experience and knowledge to assist you with your pre-planning needs. Call us to setup an appointment or utilize our online Secure Preplanning Form.

If you have any questions, or would like assistance with this form, please call (225) 753-1440

Online Preplanning Form

Free Text

Personal Information

Who is this plan for?

First Name

Middle Name

Last Name

Free Text

About You

Email Address

Phone Number

Free Text

Family, Work, & Education

Free Text

Family Information

Father's Name

Father's Address

Mother's Name

Mother's Address

Marital Status

Spouse's Name

Spouse's Maiden Name

Place of Marriage

Date of Marriage

Free Text

Additional Family Members

Siblings (alive)

Siblings (deceased)

Children (alive)

Children (deceased)

Grandchildren (alive)

Grandchildren (deceased)

Great-Grandchildren (alive)

Great-Grandchildren (deceased)

Free Text

Education History

School Name

Highest Level of Education

School Location

Free Text

Work History

Occupation

Company Name

Years At Company

Did this person serve in the military?

Yes

No

Free Text

Your Wishes

Visitation Options

Visitation at funeral home

Visitation elsewhere

No Visitation

Funeral Service Option

Funeral service at funeral home

Funeral service elsewhere

No Funeral Service

Reception Options

Reception at funeral home

Reception elsewhere

No Reception

Would you prefer burial or cremation?

Burial

Cremation

Final Disposition

Ground Interment (burial)

Mausoleum Entombment (above ground burial)

Columbarium (for cremation urns)

Ashes returned to family

Would you prefer to include a graveside/committal service?

Yes

No

Free Text

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! Your submission has been received!

Oops! Something went wrong while submitting the form.

About Us
Contact Us
Obituary Listing
Send Flowers
Services Overview
Planning Ahead

A Year of Grief Support

Sign up for one year of weekly grief messages designed to provide strength and comfort during this challenging time.

Please wait

Verifying your email address

Please wait

Unsubscribing your email address

You have been unsubscribed

You will no longer receive messages from our email mailing list.

You have been subscribed

Your email address has successfully been added to our mailing list.

Something went wrong

There was an error verifying your email address. Please try again later, or re-subscribe.

Share by: