Please complete the form below to register for your vasectomy. We will contact you to schedule your appointment and answer all your questions. Expect to hear from us within 24 hours.

Before you register online, you must:

  • Read the patient information section found on this web site and ensure all your questions have been answered.

  • Be sure that you do not want to bank sperm prior to vasectomy. If you are not sure, phone us for a consultation.

Once you submit this registration:

  • Our office will phone you to book your vasectomy, or to discuss the need for an office consultation.

Registration Form

If you have any questions phone 250-658-9212.

If you would like to proceed with registration, please fill out this form completely and submit. We look forward to seeing you in a few weeks!

Deal-Breakers

  • Aspirin (ASA). None is allowed for at least 7 days pre-op.
  • Anti-inflammatory drugs. None for at least 2 days pre-op.
  • Alcohol. None for 48 hours pre-op.
  • Technical issues.
    The rare patient will have scarring or some other condition at or near the vas, e.g. hernia repair. (Under these circumstances we require a pre-op consultation/examination.)

Personal Information

Contact Information

Occupation

Second Occupation

Family Information

Are you currently in a relationship?
Do you have any children together?
Do you have any children from previous relationships?

Vasectomy Preparedness

I confirm that I do not want to father any more children in my lifetime
I decline pre-vasectomy sperm banking
I have read all the information on the vasectomy website and have had all my questions answered
I know I must abstain from alcohol for 48 hours pre-operatively and 48 hours post-operatively
I know I must avoid aspirin, ASA, or any products containing this for 7 days pre-operatively
I know I must avoid anti-inflammatories (NSAIDS) for 2 days pre-operatively
I am aware of the restrictions on physical activities for the week following the vasectomy
Cancellation with less than 72 hours notice may incur a $200 cancellation fee.

Medical History

Do you engage in strenuous physical activity or sports?
Do any of the following apply to you?
Have you had any operations in the past?
Are you taking any medication?
Do you have allergies to any medications?