Instead of registering below, please call us at (800) 417-3747 ext. 1.
Instead of filling out the form below, please call us at (800) 417-3747 ext. 2 or fill our the HOPE® form.
We currently pre-register persons living in AZ, CA, CO, DE, FL, IL, NC, NV, OR, PA, TX, WA and WI. If you do not live in one of these states, simply tell your loved ones that you wish to be a donor so they are aware to call Science Care either at your entry into hospice care or at the time of need.
Please complete the form as accurately as possible. Misspelled names, addresses, phone numbers, and emails can delay or cause issues with your registration.
* You have left some required fields empty. Please correct fields in red.
After completing the online registration form above, you will be taken to a web page with a link to complete and download the “Donation and Cremation Consent Authorization Form.” The form must be completed, initialed, printed, signed and dated by the registrant, and signed by two witnesses.