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

We will call you back within 48 hours to confirm your appointment and answer your questions.

Thanks for booking with us.

  • Patient Information

  • Type "N/A" if none
  • 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
  • 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 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 surgical supplies that you will need after your vasectomy provided for you so you will not need to go from store to store to buy them as your time is valuable. 5) 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. 6) Your online booking fee of $55 will be waived. 3) One year unlimited 24/7 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:

Contact Us