Check if you’re suitable for a vasectomy
Name
Tel
Age
Do you have any background illness:
yes
no
Do you have any allergies or sensitivities:
yes
no
How did you hear about the vasectomy:
I was looking for a means of contraception and I came to you.
I heard about a vasectomy and wanted to receive more information.
I have decided that I would like to perform the surgery. I am at the stage of choosing the right doctor
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