Transportation Requisitions

Transfer or Removal Request

* Indicates required field

Funeral Home In charge *

Funeral director request service *

Follow up contact email or phone *

Name of the deceased *

First

Last

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) *

Transfer Service Requested *

Transfer Level 1 - Transfer required within 24 hours allowing us to place into a schedule Transfer Level 2 - Urgent transfer requiring one driver Transfer Level 3 - Urgent transfer requiring one driver and one assistant Airport Transfer

Name / Address of pickup location *

Sheltering Facility being used *

Sheltered at Our Funeral Home Sheltered at OMEGA Other Location

Signed release authorization *

Max file size: 20MB

Additional information *

Submit

Mortuary Requisitions