Online Preplanning Form

Pre-planning your funeral arrangements not only gives you peace of mind about your final wishes being honored, but alleviates some of the stress and burden your loved ones are going through as they experience the grief associated with the loss.
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The staff of Moloney Family Funeral Homes is here to assist you with your funeral pre-needs by helping you make decisions about your funeral service in advance and guide you in helping eliminate some of the unnecessary stress brought on by a loved one’s death.

You may fill out as much or as little as you wish, but we do need your basic contact information so we can follow up with you to get any additional information we may need to complete your arrangements.

If you have any questions, or would like assistance with this form, please call (631) 588-1515

Personal Information

First Name

Middle Name

Last Name

Relationship to Form Applicant

Which Location

About You

Email Address

Phone Number

Family, Work, & Education

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

Additional Family Members

Siblings (alive)

Siblings (deceased)

Children (alive)

Children (deceased)

Grandchildren (alive)

Grandchildren (deceased)

Great-Grandchildren (alive)

Great-Grandchildren (deceased)

Education History

School Name

Highest Level of Education

School Location

Work History

Occupation

Company Name

Years At Company

Did this person serve in the military?

Your Wishes

Visitation Options

Funeral Service Option

Reception Options

Would you prefer burial or cremation?

Final Disposition

Would you prefer to include a graveside/committal service?

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 specific foods or beverages you would like to make available to your family and guests at the services.

Please list any poems, religious texts, or readings you would like to be read at your services.

Is there a special story, personal thank you, or message of hope you would like to be read during your services?

Please list any interests or hobbies you would like to include into your services.

SUBMIT