Same day Vasectomy Intake Form

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Fill out this form to have a SAME DAY VASECTOMY!

Same Day Consult. No Wait. Drive In & Drive Out!

Vasectomy intake form

Deposit (If you are cleared medically)

  • We will contact you at your desired date and time to book your vasectomy.
  • Your vasectomy will be confirmed upon receiving a $200.00 deposit. 
  • You can pay your deposit online. We will send you a link to pay your deposit after we have booked a date for your vasectomy.
  • Your deposit must be paid within 48 hours from your phone call.