Vasectomy Edmonton


  Contact : 780-469-5299

Online Registration for Vasectomy

Please go ahead and complete the short registration form below. This will save you some paperwork later and permit us to get your booking processed right away. We will call you to schedule your appointment as soon as we get your registration.

If you have not already done so, please see the Vasectomy Fees page for detail on our optional Premium Vasectomy package. The Premium Package includes no-needle anaesthesia, your aftercare supply kit, and telephone follow-up instead of additional clinic visits after your procedure.

Also, please note that if you don’t already have a doctor’s referral for your vasectomy you should get one before your procedure – from your own doctor or from a clinic. We can help with this if needed. Just give us a call at 780-469-5299.

Vasectomy Registration Form

  • Patient Information

  • Type "N/A" if none
  • Referring Doctor

  • Family Doctor (If different from referring doctor)

  • Family Information

  • 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

  • Premium Service

  • Please see the Vasectomy Fees page for more detail on this $250 optional non-insured service.
  • Vasectomy Agreement

    You must consent to the following: