Vasectomy Registration

Vasectomy Registration2019-03-25T16:37:43-04:00

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

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

Thanks for booking with us.

  • Patient Information

  • Date Format: DD slash MM slash YYYY
  • (if available)
  • (if applicable)
  • Referring Doctor (if applicable)

  • Family Information

  • Enter “none” if none.
  • Enter “none” if none.
  • Enter “none” if none.
  • Enter “none” if none.
  • Contraception

  • Medical History

  • Surgical History

  • Medications

  • Enter "none" if none.
  • Allergies

  • Enter “none” if none.
  • Vasectomy Agreement

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

Gentle Procedures Canberra clinic is open.

We are operating with modified procedures to support social distancing and infection control.

Please contact us now to book.

Please read our COVID-19 Information Page.

Take care and stay safe.