Arrange a direct cremation form Your Details This is the person who will be responsible for arranging and paying for the direct cremation.TitlePlease selectMrMrsMissMsDrMxReverendProfFirst Name *Last Name *The person who died is your *Your address detailsContact detailsEmail Address *Telephone *Details of the person who has diedTitlePlease selectMrMrsMissMsDrMxReverendProfFirst Name *Last Name *Were they known by another name? (optional)This is so we refer to them the way you would want us to.Gender *MaleFemaleDate of Birth *Example 31 05 1970Date of death *Example 16 04 2023Religion (optional)Home address *Medical informationIs the coroner (England and Wales) / procurator fiscal (Scotland) investigating the cause of death? *Yes - £0 sometimes people say yes and then the doctors issue so there needs to be a warning that if the coroner does not issue the paperwork an additional £82 will need to be paid before collecting the deceased from the mortuary.No - £82 for doctors cremation formsUnsure - £82 to be refunded if the coroner issues the paperworkIf the coroner is involved and opens an investigation you don’t need to register the death just yet. You can continue to make arrangements for the direct cremation by completing this form. If you need any more information, contact the coroner’s office or call us on 0333 188 2810.Does the person who has died have a pacemaker or implants? *Yes - £50No - £0Unsure - £50 refunded if we find out they don’t (generally families would know)Don’t worry if you don’t know, we can speak to their GP to find out.Has the death been registered? *YesNoRegistering the death is a formal record done by the Registrar of births, deaths and marriages. If the coroner is not involved you should do this within 5 days of the death. You do need to have registered the death before we can carry out the cremation.Location Let us know where the person who died is. We’ll then call you to let you know when our team will arrive to bring them into our care.Location *EnglandWalesType of residencePlease selectHomeHospitalHospiceNursing HomeAirportOther Because they are at home or in a nursing home call us on 0333 188 2810. This is so we can arrange to bring them into our care more quickly. Other residence nameAddress *Pricing information £1050Would you like to know when the cremation will take place? *YesNoThe ashes Our team oversee every stage of care from the very first call to the hand delivery of ashes, including the cremation itself at our state-of-the-art venue, Chase and District Memorial Park, in Staffordshire. You can choose what happens to the ashes after the cremation.I want the ashes to be: *Collected by family from the crematoriumScattered in our beautiful memorial parkReturned to a UK address within 10 working daysPay now or pay later We need to take payment from you within 48 hours. You can continue here and pay online or if you choose to pay later, we will call you back to take payment over the phone or discuss alternatives.PaymentPay nowPay laterClick here to pay via StripeConsent *I confirm that I am responsible for the payment and arrangement for the proposed Direct Cremation and I have read and understood the terms and conditions , including the 'How my information is used' section.What happens next? You'll be contacted by one of our colleagues. We will call you back within one working day. We will call you during our contact hours: Monday to Friday: 9am - 5pm (except bank holidays) Send Message
