Patient Registration Forms

About Forms

All forms provided on this website, in printed and electronic form, are the copyrighted property of The Vasectomy Clinic® and are provided only for use in obtaining care for our patients. They may be printed, copied, or transmitted electronically only as required for that purpose. Printing, copying, or electronically reproducing or transmitting forms in whole or in part for any other use without the express written consent of the owner is prohibited.

A PDF reader is required to view and print Forms. You may download the Adobe Reader application free at the Adobe website.

If you are unable to print the forms, please telephone us or use the contact us page to request that we mail the forms to you.

Informational Booklet

This contains the essential information for patients in an 8 page booklet. You may download and print the Informational Booklet or read the contents on your computer.

Informational Booklet (404k pdf) (8 pages)

Patient Forms

Please download and print these three forms. Submit your completed forms by mail or fax.

Registration Agreement (83k pdf)
Health Questionnaire (89k pdf)
Consent Form (80k pdf)

After Vasectomy Instructions

After Vasectomy Instructions (139k pdf)  (2 pages)