As part of care at the180, we want to stand with you in times of grieving.

If you are aware of a death, please fill out this form and Allan MacInnes, our Director of Pastoral Care, will be in touch.

 
Name of Person Filling Out This Form *
Name of Person Filling Out This Form
Contact Phone Number *
Contact Phone Number
(In case we need to follow up with you for further details.)
For example, in need of visitation, etc.
Contact Phone Number for Family
Contact Phone Number for Family
(So that we can contact the family directly as needed.)