Intake Form 

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We understand that this is a difficult time for you. Thank you for taking the time to provide this important information so that we can better serve you and your family.

About the Deceased:
First, Middle, Last
Please click to change date






(if not applicable, please put "NA")

Length of time living here?

Please click box to change date
Please click box to change date




Send Us a Message

Contact Us

Call Us
1-334-222-8440 

location_on Address
Andalusia Location
206 Stanley Ave
Andalusia, AL 36420

Lockhart Location
2871 Alabama Highway 55
Florala, AL 36442

Clio Location
1411 Blue Springs Street
Clio, AL 36017

Evergreen Location
705 Perryman Street
Evergreen, AL 36401


access_time Hours
Mon - Fri 9:00 am to 4:30 pm

You are welcome to call us any time of the day, any day of the week, for immediate assistance. Or, visit our funeral home in person at your convenience.

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