Please note that you will need a physician’s referral to any of our doctors (Dr. Jack Chang or Dr. Neil Pollock) before an appointment can be booked (through a family physician or walk-in clinic). Ask them to fax their referral to our office.

There is a $55 online registration fee which is waived with our Premium Safety, Comfort and Convenience Package.

By registering online, you will be combining two visits (consultation and procedure) into one. Our doctors will call you the day before surgery to go over your registration form.

After submitting you must ensure you get to the Vasectomy Registration Thank You page. If you did not reach this site, you have an incomplete registration with errors on it that you must correct and submit again. Please ensure your email will not filter out emails from info@pollockclinics.com.

  • Patient Information

  • Type "N/A" if out of country
  • Type "N/A" if none
  • Referring Doctor (GP or Walk In Clinic 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
  • Sperm Storage

  • For more information on sperm storage, please refer to : http://www.olivefertility.com/our-services/fertility-preservation/sperm-freezing
  • Premium Service

  • SUMMARY OF OUR PREMIUM SERVICES PACKAGE:
  • 1) No-Needle Anesthetic scientifically proven to provide increased comfort, reduced anxiety, reduced risk of hematoma/post-operative bleeding and reduced time of surgery.
  • 2) All follow ups and semen test results discussed with you by telephone to ensure easy and prompt follow up at your convenience, condensing your entire procedure with us into one single visit appointment.
  • 3)All your post-operative surgical supplies that you will need after your vasectomy provided for you in a pre-packaged kit so you will not need to go from store to store to buy them as your time is valuable.
  • 4)Skin glue (Glustitch) specially formulated by our clinic used to immediately stop skin bleeding and to seal the wound immediately to reduce the risk of infection and to promote faster healing.
  • 5)Your online booking fee of $55 will be waived.
  • 6)Lifetime unlimited personalized access to our physician’s personal cell phone for peace of mind whenever you need wherever you are.


  • Vasectomy Consent and Agreement

    Please review and consent to the following: