Vasectomy Registration

Vasectomy Registration 2018-04-02T11:08:56+00:00

Please register below.

After submitting you must ensure you get to the Vasectomy Registration Thank You page. If you do not reach this page, 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 none
  • Referring Doctor (if applicable)

  • 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
  • Vasectomy Consent and Agreement

    Please review and consent to the following:
Call us : 604-717-6200