Forms

Information Packet

When you contact us by telephone or email, we will mail you our complete Information Packet, containing the Informational Booklet and all three Patient Registration Forms. You can also read and print these by clicking each Form on this page.

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 to request that we mail you our Information Packet.

Informational Booklet

 

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 (477k pdf) (8 pages)

Patient Registration Forms

Please save each blank form to your computer as a pdf file. Open in Adobe Reader to type into the form, then save the completed form again. You can then submit your completed forms electronically using our secure upload portal. Alternatively, you may print the blank forms, write in your information, and send them to us by mail or fax, or scan them and send by our secure upload portal.

Consent Form
Registration Agreement (142k pdf)
Health Questionnaire (217k pdf) Consent Form (76k pdf)

The After Vasectomy Instructions also appear on page 8 of the Informational Booklet. The Test Request Form can also be found on the Testing Schedule page.

After Vasectomy Instructions

Test Request Form

test request form
After Vasectomy Instructions (118k pdf)Test Request Form (76k pdf)

Copyright Notice: 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.