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Minimal discomfort procedures
Adult circumcision Clinic in Melbourne
Same Day Circumcision Form (Less than 4mths old)
Same Day Vasectomy Intake Form
Baby Circumcision Intake Form
This form is only for boys LESS than 4 months old
Boys GREATER than 4 months must have a phone/video/face to face consultation before you book the circumcision
Circumcision intake form (less than 4mths)
Child’s First Name
Child’s Last Name
Does your son suffer from any medical conditions?
Does your son take any medication?
Does your son have a history of surgery?
Do you, your son or your son’s other parent suffer from any allergies?
Please list these allergies
Do you, your son or your son’s other parent suffer from a bleeding disorder?
Do you, your son or your son’s other parent suffer from any genetic conditions?
Which location would you like your son’s circumcision?
What time/day would you like us to contact you (Mon-Fri)?
Mon (9am – 1pm)
Mon (2pm – 5pm)
Tue (9am – 1pm)
Tue (2pm – 5pm)
Wed (9am – 1pm)
Wed (2pm – 5pm)
Thurs (9am – 1pm)
Thurs (2pm – 5pm)
Fri (9am – 1pm)
Fri (2pm – 5pm)