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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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Child Circumcision Registration (00 – 14 years of age)2022-02-21T09:40:49+09:00

Child Circumcision Registration (00 - 14 years of age)

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  • In accordance with the Privacy Act (1988), all information collected by Gentle Procedures Clinic Queensland is treated as confidential. To protect your privacy Gentle Procedures Clinic Queensland operates in accordance with this act. (Please tick the items listed to indicate your consent to disclose the following items).
  • COVID-19 Questionnaire (Parent 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

  • If you have not received your Medicare card for your child, please enter parents Medicare card number and reference number in child as 0.
  • Parent / Legal Guardian Details:

    If YES, a copy is required to be reviewed by the doctor before the procedure is performed.
  • Drop files here or
    Accepted file types: pdf, Max. file size: 64 MB.
      Please note, the only accepted format is PDF
    • General Doctor Details / Obstetrician Details If child <6 months

    • Do you have a doctor (GP) that your son visits? If so please provide their details and we will send them a letter stating the procedure performed.
    • Medical History (Tick if appropriate)

    • Type n/a if none
    • Type n/a if none. Example medications include (Warfarin, Xarelto). If you are taking any medication please list and you will need to call 1300 755 055 as blood thinners thin the blood.
    • 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 stock Xylocaine 2% Jelly please do not purchase an alternative.
    • :
      * Please apply the numbing cream 45 - 60 minutes before the procedure.
    • * Please apply the numbing cream on the head of the penis and the base of the penis.
    • * We suggest using a small amount, about the size of a 20 cent piece.
    • Pain Management

      Although we use effective local anaesthetic and additionally for some patients sedation and Penthrox (3+ years of age), we cannot guarantee a painless procedure and some patients do experience break through pain.
    • Weight

      For Infants & Babies - you MUST get your son weighed 2 -3 days before his appointment & call our office with the details - 07 2103 2322. Your child's weight determines how long we wait in between each stage and how much local anaesthetic we can safely use. The treating doctor will perform a nerve block by injecting either side of the penis into the subcutaneous tissues and at the base of the penis. Risk of local anaesthetic: fitting, coma, respiratory depression, cardiac arrythmias and death.
    • Kg
    • 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.
    • Please enter a note and this will be brought to the treating doctors attention at your appointment.
    • 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 complications may include

      Please note it is our responsibility to ensure you are aware that there are potential complications with any medical procedure, including a Circumcision. You must understand these before your son's procedure is performed. If there is anything you do not understand please add to the questions section.
    • Please enter a note and this will be brought to the treating doctors attention at your appointment.
    • 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.
    • Technique Used at Gentle Procedures Clinic Queensland:

      The Pollock Technique™ uses a Mogen clamp. After much research, we find this approach is less invasive, there is less handling of the tissue. It is also 10 x faster than traditional circumcisions. The shorter the duration of any surgical procedure, the easier the recovery.
    • 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 question we will be unable to provide you with things such as a medical certificate or a letter to your GP.
    • If you answer NO to this you will not receive appointment SMS messages.
    • (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.
    • Parent Details

    • 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.
    • 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.

    Our Practice Locations

    Underwood Vasectomy & Circumcision Clinic
    2 Springvale Circuit Underwood, QLD, 4119

    Spring Hill Vasectomy & Circumcision Clinic
    Silverton Place. Level 5, Suite 53. 101 Wickham Terrace Spring Hill, QLD, 4000

    Toowoomba Vasectomy & 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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    • Child Circumcision Registration
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