Mortuary Requisitions

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Local Mortuary Requisitions

Initial Removal Request

* Indicates required field

Funeral Home Requesting Service *

Funeral director in charge *

Follow up phone number *

Follow up Email *

Name of the deceased *

First

Last

[object Object]

Confirm their identity by referencing:

Personal Health Number (PHN) (1234-000-000) *

Coroner Case Number (2021 - 000 - 0000) *

Date of Birth (Month - Day - Year) *

Date of Death (Month - Day - Year) *

Transfer Service Requested *

Required within 24 hours allowing us to place into a schedule Urgent requiring one driver Urgent requiring one driver and one assistant Airport Transfer

Name and / or Address of pickup location *

Sheltering Facility being used *

Sheltered at your Funeral Home Sheltered at Omega Mortuary Services Other Location

Signed release authorization *

Max file size: 20MB

Additional information *

Submit

Mortuary Services Requisition

* Indicates required field

Funeral Home Requesting Service *

Funeral Director In Charge *

Follow up Contact Email or Phone *

Follow up Email *

Name of the Deceased *

First

Last

Confirm their identity by referencing:

Date of Birth (Month - Day - Year) *

Date of Death (Month - Day - Year) *

Personal Health Number (PHN) (1234-000-000) *

Coroner Case Number (2021 - 000 - 0000) *

Tasks to be completed by what date and time *

Decedent Care

Decedent Care for Disposition with no ceremony *

Minimum Decedent Care and Casketing only Dress and Casketing

Pacemaker or any internal device *

Known to have a pacemaker Not supposed to have a pacemaker Unknown Other internal device

Body Preparation *

Embalming Embalming - Autopsied case Embalming - Major surgery or trauma case Sanitation Care for viewing (no embalming) Dressing and casketing by Omega Staff Dressing and casketing by funeral home staff

Body Preparation Authorization Upload File *

Max file size: 20MB

Grooming Instructions *

Do NOT shave Shave facial hair Shave but keep moustache Trim beard Shave head Curl Hair Dye Hair Use provided product

Cosmetics *

Do not apply cosmetics Light cosmetics Use provided cosmetics

Decedent Photo *

Max file size: 20MB

Casket / Cremation Container *

Being delivered by our staff Being delivered by the family Being delivered by the supplier Already at Omega Omega picking up

Model name of casket / cremation container *

Vehicle and Staffing Assistance *

We will use our own vehicles Rental of Omega hearse with driver Rental of Omega hearse with driver and second attendant Flower Van Assistance

Additional Pallbearers Required *

1 Pallbearer 2 Pallbearers 3 Pallbearers 4 Pallbearers 5 Pallbearers 6 Pallbearers 7 Pallbearers 8 Pallbearers

Ceremony Location *

Entire ceremony offsite Decedent to return to Omega after ceremony Rental of Omega Multipurpose room for private gathering

Ceremony Location #1 *

Ceremony Location #2 *

Omega to Transport Directly to Crematorium: *

Additional Comments *

Submit

Phone: 778-246-6730

# 2 - 26647 Fraser Highway,
Aldergrove, BC V4W3L1
Email: [email protected]

Fax: 778-621-2752