In providing my full name and social security number below, I assert that I am of sound mind and disposition, and desire to be of service to my fellow man, do hereby donate and bequeath my body upon my death to be used, in whatever manner appropriate, for the training of medical personnel and the advancement of medical science through education and research.
I further direct that my next of kin or Executor immediately telephone the Willed Body Program at UNT Health Science Center, Fort Worth, at 817-304-3763, to arrange for removal of my unembalmed remains.
I authorize the Anatomical Board of the State of Texas, to transport the willed/donated body herein described out of the state of Texas in the event that the holding institution and the Executive Secretary of the Board have determined that an excess of bodies for scientific uses currently exists in the State of Texas
It is understood that the Willed Body Program at UNT Health Science Center will transport and prepare the remains, if acceptable, for medical education and research.
I understand that UNT Health Science Center reserves the right to decline a body that has been embalmed. In addition, I understand that I cannot be guaranteed that my body will be accepted at the time of death. If I am morbidly obese, emaciated, or have a contagious disease (e.g. HIV, Hepatitis, active TB, etc.), if an independent autopsy is performed, my body may not be accepted by the Willed Body Program. If the Willed Body Program is unable to use my body for these or other reasons, my survivors will need to make other arrangements for the final disposition of my body, and the Willed Body Program is not responsible for any costs associated with other arrangements.
I hereby relinquish all rights and claims regarding herein described body, by any person whatsoever, and direct that in accepting and using this body for scientific purposes, and disposing of the body, neither the Anatomical Board of the State of Texas nor the receiving institution shall incur any liability, and no claim shall arise against that institution in any manner.
Complaints or inquiries regarding, a willed or donated body should be directed to the Secretary-Treasurer of the Anatomical Board of the State of Texas. The name and address of this individual may be obtained from the institution to which the body was delivered.