Body Donor Program - Body Donation Inquiry Form - School of Medicine and Public Health

Note: The inquiry form is different from the registration and consent form. You can download the body donation registration and consent form (PDF) or request the form by phone, email or this inquiry form.

"*" indicates required fields

Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

I am requesting information:*

For myself

On someone else's behalf

Name

Of the person you are requesting information for.

First Last

Relation to the Potential Donor

Please mail me the donation information packet, including the registration and consent form.*

Yes

No

Questions

If you have any questions about the program or donation process, list them and our staff will get back to you.

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Program Contact Information

General Information or Donation Information Packet Request
608-262-2888
Monday through Friday, 8 a.m.–4:30 p.m.

Regarding a Death of a Registered Donor
608-262-2800
At any time of day including evenings, weekend, and holidays

Thank you for your interest in donating!