Please complete the registration form below for no-scalpel no-needle vasectomy.

We will call you back within 24 hours to confirm your appointment and answer your questions.

Thanks for booking with us.

Vasectomy Registration Form

  • Patient Information

  • Date Format: DD slash MM slash YYYY
  • Type "N/A" if none

  • Family Doctor (If different from referring doctor)

  • Surgical History

  • Medications

  • Type "N/A" if none

  • Sperm Storage

  • Premium Service

  • Includes: NO-NEEDLE ANAESTHESIA for your comfort. ALL AFTERCARE SUPPLIES to save you time. FOLLOW-UPS BY PHONE so you don't have to travel back to the clinic. Please see the Vasectomy Fees page for more detail on this $245 optional uninsured service.

  • Vasectomy Agreement

    You must consent to the following:
  • This field is for validation purposes and should be left unchanged.