Director on Call Intake Form

Director on Call Intake Form
Welcome to Director on Call! Please complete the following form in order for our programmers to be able to best program your account. If there is any additional information that needs to be added, of if you have more than one location, please contact your Account Manager or the Lead Programmer.
Who is your Account Manager *

Contact Information
Please complete YOUR contact information as the person who is filling out the forms on behalf of your funeral home.
Name *

First Name Last Name
Contact Phone Number *

Area Code Phone Number
Email Address *
example@example.com
What is your position at the funeral home? *

Company Information
Funeral Home Name *
Do you have more than one location? *

Yes No
Owner's Name

First Name Last Name
Manager's Name

First Name Last Name
Main office phone number *

Area Code Phone Number
Alternate Office Phone Numbers (Please include unlisted/toll-free numbers as well)
Fax Number

Area Code Phone Number
Company Email Address
example@example.com
Website *
Company Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Billing Address (if different from above)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Cross Streets
Landmarks
Detailed Directions from Major Areas *
Office Hours (Please include days and operating hours) *
Is your office closed on ALL Stat Holidays

Yes No
If no, please indicate any holidays your office is closed on.
Time Zone
Do you recognize daylight savings time *

Yes No

Funeral Home Information
Please provide a brief summary of your funeral home, and the services you provide. As well, any additional information about your funeral home which you feel will assist our operators when answering your calls. Please note that if you have more than one location, this section will need to be duplicated. Your Account Manager will be in touch regarding duplication.
Funeral Home Description *
How do you plan on using the toll-free number we will provide? *

Advertise or Give the Number Out Call Forwarding Purposes
Please list the phone number(s) that will be forwarded. This includes toll-free and/or unlisted numbers.
What forwarding option will you be using? *

Regular Call Forwarding (Where forwarding is either on or off) Call Forward/ No Answer (Where a call will forward after a set number of rings) Call Forward/ Busy (Where a call will automatically forward if busy
Are there any recommended flower shops (Names and Phone Numbers)
Please list any local hospitals and nursing homes (Names and Phone Numbers)
Please list any local cemeteries (Names and Phone Numbers

Call Types
Please provide a general example of the calls we should expect on your line and if they should be treated as urgent or non-urgent.

Please specify if you'd consider these calls urgent or non-urgent *

	Urgent	Non-Urgent	Not Applicable
Office Calls
Personal Calls
Prearrangement Calls
Pricing Calls when Death is Imminent
Memorial Donations
Florist Calls
Newspaper Calls
Death Certificate Calls
Death Calls from a Facility
Death Calls from a Family
Coroner Calls
Release Calls

If there are any additional call types we should be aware of? Please include the call type and whether it's to be considered urgent or non-urgent.

Answering
In this section, please go over how you want your calls answered and when we will be answering on your behalf.
How would you like us to answer the line? *
When will we be answering the line? *

After Hours/Weekends Overflow calls during office hours Overflow calls 24/7 All Calls 24/7
Should we accept collect calls?

Yes No
What should we advise callers when asked when they will receive a call back? Please indicate whether this should vary based on time or day or type of call.
Is it acceptable for our staff to offer condolences when taking a death call?

Yes No
Please provide any further information we should know when answering your line.

Message Taking
Below are the basic questions we will ask on all calls, if you would like us to ask any additional questions, please indicate below.
GENERAL MESSAGE
For
Caller Name
Company Name
Caller Contact #
Caller Alternate
# Message / Nature of Call

DEATH CALL MESSAGES
For
Caller Name
Caller Number
Calling From (If nurse/doctor/coroner etc)
Relation (If family)
Name of Deceased
Location of Deceased (Residence, Nursing Facility, Hospital)
Phone Number @ the Location
Street Address
City
Message
Please add any additional questions and indicate if they are call type specific

Additional Services
Would you like a daily recap of your messages?

Yes No
If yes, what time do you want your daily recap sent?

: Hour Minutes AM/PM Option
What email would you like the daily recap sent to?
example@example.com

Staff Contact Information
Please provide a list of all staff that we may need to contact, with all contact methods. Please indicate if phone numbers are office, mobile or home numbers.
We would appreciate the following structure if possible:

Name
Position/Title
Contact 1
Contact 2
Contact 3
Email Address

Any other information about the contact that would be relevant to us
Staff Contact Information

Browse Files

Cancel of
If you do not have a current staff directory, please fill out the following contact information for those who will be answering calls after-hours.
Contact Person # 1
Name

First Name Last Name
Position/Title
Contact # 1

Area Code Phone Number
Contact # 2

Area Code Phone Number
Contact # 3

Area Code Phone Number
Email
example@example.com
Any other information about the contact that would be relevant to us.
Contact # 2
Name

First Name Last Name
Position/Title
Contact # 1

Area Code Phone Number
Contact # 2

Area Code Phone Number
Contact # 3

Area Code Phone Number
Email
example@example.com
Any other information about the contact that would be relevant to us.
Contact # 3
Name

First Name Last Name
Position/Title
Contact # 1

Area Code Phone Number
Contact # 2

Area Code Phone Number
Contact # 3

Area Code Phone Number
Email
example@example.com
Any other information about the contact that would be relevant to us.
Contact # 4
Name

First Name Last Name
Position/Title
Contact # 1

Area Code Phone Number
Contact # 2

Area Code Phone Number
Contact # 3

Area Code Phone Number
Email
example@example.com
Any other information about the contact that would be relevant to us.
Contact # 5
Name

First Name Last Name
Position/Title
Contact # 1

Area Code Phone Number
Contact # 2

Area Code Phone Number
Contact # 3

Area Code Phone Number
Email
example@example.com
Any other information about the contact that would be relevant to us.
Should be Empty:

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Director on Call Intake Form

Non-Urgent Calls

Urgent Calls

Please indicate what we should do with messages you identified above as URGENT.

Contact Person # 1

Contact # 2

Contact # 3

Contact # 4

Contact # 5

Director on Call Intake Form

Non-Urgent Calls

Urgent Calls Please indicate what we should do with messages you identified above as URGENT.

Contact Person # 1

Contact # 2

Contact # 3

Contact # 4

Contact # 5

Urgent Calls

Please indicate what we should do with messages you identified above as URGENT.