After you’ve scheduled your appointment, please complete the registration form below for no-scalpel vasectomy.

We will contact you to confirm your appointment and answer your questions.

  • Patient Information

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

  • Family Information

  • Type "N/A" if none
  • Medical History

  • Surgical History

  • Medications

  • Type "N/A" if none
  • Allergies

  • Type "N/A" if none
  • Vasectomy Agreement

    You must consent to the following:
  • Enter n/a if not applicable.