Part A – to be read and completed by the donor

Having read the information pamphlet on the bequest of bodies for anatomical study, I consent to the bequest of my body to the Department of Anatomy. I understand that the principal use of bequests is for teaching anatomy to medical, dental, physiotherapy, physical education, and science students, and that several academic staff and postgraduate students in the Department of Anatomy are also using human bodies for research purposes.

I accept that my remains will be cremated, and the ashes scattered on the rose garden at Andersons Bay Cemetery, Dunedin, and I give permission for the Department of Anatomy to retain, indefinitely, any material which may be of value for future teaching and/or research.

I am aware of the circumstances which may preclude my bequest being accepted upon my death, as outlined in the information pamphlet. I understand that my estate should make alternative arrangements in case circumstances prevent my body from being accepted at the time of my death. I am happy for the Department to obtain my medical and/or dental records through my General Practitioner and/or Hospital/Dental Practitioner, as indicated on Bequest Form E (Request for Release of Medical and Dental Information). The Department may extract information from my records that is relevant to the anatomical examination of my body. I understand that my identity will be always kept private, and personal information will not be given to students.

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