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Gentle Procedures Circumcision & Vasectomy Clinics – Dr David Hunt – The Pollock Technique Logo Gentle Procedures Circumcision & Vasectomy Clinics – Dr David Hunt – The Pollock Technique Logo Gentle Procedures Circumcision & Vasectomy Clinics – Dr David Hunt – The Pollock Technique Logo
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Adult Circumcision Registration (15+ age) – Preview Page2022-02-21T09:39:44+09:00

Adult Circumcision Registration (15+ age) - 2020

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  • COVID-19 Questionnaire (Patient to complete)

  • If you answered YES our doctor will be in contact with you prior to your appointment to confirm if you can attend this appointment.
  • Patient Information

  • Your medicare number should be 10 digits long
  • General Doctor Details

  • Allergies

  • Medical History

  • (name/dosage)
  • Sexual Health Screening

    Due to the nature of the medical procedure you are about to undergo it is vital we know your sexual health history. Have you been diagnosed with:
  • Please advise of the Doctor Name and contact telephone number
  • Application of Numbing Cream (Xylocaine 2% Jelly) at Home Before Appointment

    The most significant part of our pain management is the local anaesthetic injections. The use of numbing cream before injections helps to mitigate pain. The cream is effective in 5-10 minutes, however there may be additional benefit putting it on for up to one hour before the procedure. We recommend using Xylocaine 2 % Jelly, it is relatively safe to use and is sold over the counter at chemists. There have been reports of adverse events when used in high doses over large areas and in the mouth.
  • ** Do not purchase Numit

    If your pharmacy does not sell Xylocaine 2% Jelly do not purchase an alternative.
  • :
    * Please apply the numbing cream 45 - 60 minutes before the procedure.
  • * We suggest using a small amount, about the size of a 20 cent piece.
  • * Please apply the numbing cream on the head of the penis and around the base of the penis.
  • Weight

  • kg
  • cm
  • Circumcision complications may include

    Please note it is our responsibility to ensure you are aware that there are complications with any medical procedure, including a circumcision. You must understand this before the procedure is performed. If there is anything you do not understand please leave unticked and this will be discussed at your appointment. (The number in brackets is the risk level for that complication)
  • If you have any questions or concerns with the above complication section please list your questions here and it will be discussed in your consultation.
  • Circumcision Consent

    Please note it is our responsibility to ensure you are aware that there are complications and risks with any medical procedure, including a Circumcision. You must understand the risks before the procedure is performed. If there is anything you do not understand please add to the questions section.
    I understand that it may be necessary for the doctor to use some or all of the following modalities to stop any bleeding should it occur: PRESSURE BANDAGE / SKIN GLUE / BIPOLAR CAUTERY / SUTURING.
  • If you have any questions or concerns with the above consent section please list your questions here and it will be discussed in your consultation.
  • Circumcision Consent / Privacy / Release of information:

  • In accordance with the Privacy Act (1988), all information collected by Gentle Procedures Brisbane is treated as confidential. To protect your privacy Gentle Procedures Brisbane operates in accordance with this act. We may use your information provided for any of the following:
  • If you answer NO to this you will not receive any appointment confirmation SMS as you have indicated no
  • If you answer NO to this means Dr Hunt cannot attempt to contact you post operatively as you have indicated no.
  • If you answer NO to this that means we cannot email you your receipt or aftercare instructions.
  • Please use your mouse or finger to digitally sign and consent to all items in this questionnaire. Please ensure to sign within the box provided.
  • The date you have digitally signed this document.
  • This field is for validation purposes and should be left unchanged.

Practice Locations

Gold Coast Clinics
Gold Coast Vasectomy and Circumcision Clinic
1b/15-21 Lake Steet, Varsity Lakes, QLD, 4227

Brisbane Clinics
Underwood Vasectomy and Circumcision Clinic
2 Springvale Cct, Underwood, QLD, 4119

Bowen Hills Vasectomy and Circumcision Clinic
8/7 O’Connell Tce, Bowen Hills, QLD, 4006

Oher Qld Clinics
Toowoomba Vasectomy and Circumcision Clinic
881 Ruthven Street, Toowoomba City, QLD, 4350

Contacting Our Office

Telephone
07 2103 2322

Facsimile
07 3102 6164

 

Office Hours

  • Monday to Friday 8.30am – 5.00pm
  • Weekends & Public Holidays – Closed

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Comfort In - Offering Needle Free Anaesthetic for Vasectomies Performed with Gentle Procedures Clinic Qld
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