If you decide to schedule a procedure, please complete this online registration before calling the clinic. Your credit card will not be charged until you complete the scheduling process over the phone.
This site is secure and your information is kept confidential. This registration form must be completed by the patient only.
There are many advantages to use online registration form.
You are completely informed after online registration.
It will save your time on the day of your consultation and/or circumcision.
You are able to provide the accurate information in the privacy of your own home or office.
We are able to review your history before you arrive and to call you if there are any medical or social concerns.
To schedule an Easy Circumcision™, a $950 non-refundable and non-transferable deposit is required. We accept Visa or MasterCard credit/debit card only. This is credited toward your actual surgery cost. If you cancel or re-schedule for any reason, your deposit will not be refunded, and you have to pay new same deposit if you re-schedule your surgical appointment.
Fill in the OnlineRegistration and Deposit Form and click "Submit". Fields marked * are Required Fields.
After processing your registration form, we'll get in touch with you to schedule a suitable appointment. Kindly be aware that this process may take a few days.