VASECTOMY ONLINE PATIENT REGISTRATION

It is important to know details about your medical history, as it forms part of vital records for your treatment with Gentle Procedures Clinic.

The information you provide is confidential and will be handled per our Privacy Policy.

We kindly ask you to complete this form 48 hours before your appointment, as the information is reviewed by Dr Hunt.

By completing, signing & submitting the form, you are making an informed consent to the procedure being performed on the date of your appointment.

If you do not consent to some or all of the sections, do not complete or submit the form and contact our office to discuss 07 2103 2322

Please note most sections on this form require an entry; if you do not have the answer, please enter n/a for not applicable. If you do not have your Medicare card, please enter the number 0 in each cell.