Willed Body Program – Donation Forms
We appreciate your inquiry and interest in our Willed Body Program at UT Southwestern Medical Center. Each person who participates contributes substantially to the education of future doctors and to medical research.
If you are interested in becoming a member of the Willed Body Program
These donation forms are for healthy individuals who are capable of completing and understanding the forms. If you are completing these forms for someone under the care of hospice, please contact our staff at 214-648-2221 and press option 1 to request consideration for donation.
Please print and fill out these forms (PDF format):
- Willed Body Program Bequest Form (must be signed by two witnesses)
- Personal Data Form
- Medical Questionnaire
Please fax the completed forms to 214-648-4506 or mail them to:
UT Southwestern Medical Center
Willed Body Program
5323 Harry Hines Blvd.
Dallas, TX 75390-9143
After the completed forms are processed, we will send you a wallet card for your records.
For donations occurring at the time of death with no prior membership
After approval of the donation by a staff member, the following forms will need to be completed and faxed to our office at 214-648-4506.
Both forms shall be given to our staff at the time of removal.
If you have further questions or need assistance, please feel free to contact the Willed Body Program at 214-648-2221 or toll free at 1-888-905-9991.
Manager, Willed Body Program
Note: With few exceptions, you are entitled on your request to be informed about the information UT Southwestern collects about you. Under Sections 552.021 and 552.023 of the Texas Government Code, you are entitled to receive and review the information. Under Section 559.004 of the Texas Government Code, you are entitled to have UT Southwestern correct information about you that is held by us and that is incorrect, in accordance with the procedures set forth in The University of Texas System Business Procedures Memorandum 32. The information that UT Southwestern collects will be retained and maintained as required by Texas records retention laws (Section 441.180, et. seq. of the Texas Government Code) and rules. Different types of information are kept for different periods of time.