Vasectomy Referral

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Vasectomy is a very effective form of contraception for couples who are no longer wanting to increase the size of their family.

Find detailed information about the procedure with its advantages and disadvantages

If, having read this information, you are keen for us to send a referral locally for you to see a specialist about having this procedure performed please fill in the following form.

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Personal Details

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Questionnaire

Do you consider your family complete?: *

Have you read the previous information regarding vasectomy and the fact that there are alternative forms of contraception which are available?: *

Have you had a previous groin or scrotal injury?: *

Do you have an inguinal hernia?: *

Are you taking any anticoagulant (blood thinning) medication?: *

Where would you want to have the procedure performed?: *

Is it something you want to discuss further with a GP here or are you happy for the referral to be sent?: *

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Vasectomy Referral

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