Family and Individual Inquiry Form Please complete this form to inquire about video donation. (Scroll down as you progress.) Thank you! All information you provide is confidential and will not be shared with any third party.*I understandVideo donation is video-recording of a partial body dissection for use in our educational web-platform, autopsy.online.*I understandCompleting this form does not guarantee you or your loved one will be able to participate in video-donation.*I understandI am interested in video donation*For myself, upon my death.For my loved one.My relationship to my loved one is*SpouseAdult childParentSiblingPower of attorney for health careI or my loved one lives*In the Chicago area.In Illinois but outside the Chicago area.I am planning to arrange*Select oneDirect cremation (no viewing).Cremation (with viewing).Burial (no viewing).Burial (with viewing).Not sure yet.Please share your view of organ donation. (Select the closest option.)*Select oneI don't trust it. It's a cover for stealing organs.It's a good option, just not for me. I'm not comfortable with it.It's a good option. I'm planning to register.I'm registered as an organ and tissue donor.I anticipate my own death within:*Select one.The next month.The next 6 months.I am inquiring long term. I am not sick or dying.I anticipate my loved one's death:*Select one.In the next week.In the next month.In the next 6 months.I am inquiring long term. My loved one is not dying.Name* First Last Email* Enter Email Confirm Email Phone* Learn more about video donation. View the video donation consent form. Contact us.