Vasectomy Registration

Please complete the registration form below for no-scalpel vasectomy.

Your premium vasectomy is fully covered by OHIP. Should your OHIP card be expired you can renew it here.

Once you submit the registration form your will get an email a few minutes later with detail in the next steps – including how to get a referral if you don’t already have one.

Thanks for booking with us.

  • Patient Information

  • Type N/A if none
  • Date Format: MM slash DD slash YYYY
  • Referring Doctor

  • Family Information

  • Type "N/A" if none
  • Type "N/A" if none
  • Type "N/A" if none
  • 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
  • Vasectomy Agreement

    You must consent to the following:
  • I understand the potential complications of the surgery listed below, and have had all questions answered to my satisfaction (check each box below to confirm):
  • This field is for validation purposes and should be left unchanged.

Our Mississauga clinic has moved to 77 Queensway West, Suite 310.

Please wear a face mask when you come for your appointment. It is necessary by law.

Please do not arrive late for your appointment. For infection control reasons we limit the number of persons in clinic at any given time. If you are more than 10 minutes late, the clinic reserves the right to reschedule your appointment.