Vasectomy Registration

Vasectomy Registration 2018-10-16T09:57:12+00:00

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

Your premium vasectomy is fully covered by OHIP. Should your OHIP card be expired you can renew it here.

Once you submit the registration form your will get an email a few minutes later with detail in the next steps.

Thanks for booking with us.

  • Patient Information

  • Referring Doctor

  • Family Information

  • Type "N/A" if none
  • Type "N/A" if none
  • Type "N/A" if none
  • Type "N/A" if none
  • Type "N/A" if none
  • Contraception

  • Medical History

  • Surgical History

  • Medications

  • Type "N/A" if none
  • Allergies

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

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