State of _________________________
County of _________________________

________________________ hereby consents to the performance of an autopsy on ________________________, the DECEASED, by ____________________________. The relationship of _________________________ to the deceased is __________________.

Dated: ______________________

______________________________
______________________________

Sworn to and subscribed before me on the date stated above.

______________________________
Notary Public
My commission expires:

Consent to Autopsy
Review List

This review list is provided to inform you about the document in question and assist you in its preparation. There are a number of reasons for an autopsy; this form provides one’s official consent to that by a relative or person with legal standing regarding the individual upon who the autopsy is conducted.

After the death of a person close to you, or over whom you have legal responsibilities, attending to this document at the same time you do others can save on your emotional wear and tear under the immediately stressful circumstances following death. Getting this document notarized at that time can contribute to a lessening of stress, should it prove to be necessary to have a Consent to Autopsy done for the authorities.

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