Personalised Information Support Pack

REQUEST FORM

Complete the form below to request a pack, containing information and resources, personalised to your specific needs.

When completing the form please be as specific as you can. The more information you provide, the better we are able to understand what might be most useful to include in your pack (hence the detailed form).

Your name

First Name

Last Name

Your Email

Your Phone

(###)

###

####

Which type of pack are you requesting?

Electronic, sent via email (free)

Hard copy, posted ($20)

Is the pack for yourself?

Name of person to receive pack

(Only required if you are ordering the pack for someone else)

First Name

Last Name

Address pack is to be sent to

(Must be a physical address, not a P.O. Box)

Message to be included with pack

If you are sending a pack to someone else, feel free to let us know what message you'd like us to include, so they know the pack is from you.

Please provide an overview of your situation

This information will allow us to personalise a pack, based on your specific situation and needs. Include who has died, your (or the recipients) relationship to that person (partner, parent, child etc), whether any children are affected (and if so, their ages), and any specific needs or concerns.