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 vasectomy reversal.
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 a vasectomy reversal, a $950.00 non-refundable and non-transferable fee (payable by Visa or MasterCard credit/debit card only) is required of all patients. This is credited toward your actual surgery cost and we do NOT charge you this deposit until you have an appointment scheduled. Submitting the registration form does not submit any payment. If you cancel or re-schedule for any reason, your $950.00 will not be refunded, and you have to pay new deposit of $950 if you re-schedule your surgical appointment.
*** Please note that the card used for the deposit will be kept on file and used to get the remaining balance at the 2 week mark unless stated otherwise by the patient. If the attempt for the deposit is made and the card is declined, and the balance is not payed off by 5PM that day the surgery will be cancelled and the deposit will be lost. Please note it is the patients responsibility to be on top of their payments.
*** PAYMENT IS DUE IN FULL EXACTLY 2 WEEKS BEFORE PROCEDURE DATE.
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.
You don't need to buy an athletic supporter, we provide you a free athletic supporter.