Location & Hours
9100 N. 2nd Street, Suite 201, Phoenix, AZ 85020
Mon - Fri: 08:00 AM - 5:00 PM
Location
9100 N. 2nd Street, Suite 201, Phoenix, AZ 85020
Hours
Mon - Fri 08:00AM - 5:00PM
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Pre-Vasectomy Summary

Click here printable version Pre-vasectomy summary (Word .docx format)

Please review this information, initial after each point, and sign at the bottom:

  1. I have read the vasectomy information sheet which I have initialed, I understand it, and have no additional questions at this time ____

  2. This operation CAN fail to achieve sterility _____

  3. This operation may work initially and then fail later within the first year ____

  4. I know that the operation is a success when semen analysis confirms zero sperm (OR rare mon-motile sperm) after 20 ejaculate_____

  5. I bring in semen sample for analysis after 20 ejaculates (roughly 10 weeks after vasectomy)_____

  6. It will be safe to have intercourse without using some form of birth control once ZERO sperm (or rare non-motile sperm) have been confirmed ____

Name: _____________________________________

Signature: ___________________________________

Date: _______________

Informative Vasectomy  links:

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