Thank you for moving forward with brain donation. We hope that participating in research and receiving a confirmed diagnosis are meaningful for you.
You are completing the “Key Questions” form. With these details, Brain Support Network can assemble the brain donation paperwork, provide comprehensive instructions to all parties, and guide you how to supply specialist medical records and a “family narrative” to the brain bank.
Depending on whether the intended donor resides at a care facility, is enrolled with hospice, and has seen more than two medical specialists, this form may take 8 to 20 minutes to complete. If you don’t have the answers at your fingertips, we suggest you click on the “Save and Continue Later” link at the bottom of this form!
Fields marked with an asterisk (*) are required. If you have difficulty completing this form, please contact us. During regular business hours, we can take the information by phone. (This form is not intended to be printed.)
If end-of-life is on the near horizon (hours or days away), in addition to completing this form, please alert Brain Support Network by email or text (cell 650-814-0848). And please follow the icing instructions. If end-of-life has occurred, please complete this special form.