VASECTOMY REGISTRATION FORM

This form is mandatory, even if you’ve already been referred by your family physician. If you have not yet been referred, our office will contact your physician to obtain a referral. Please note that your physician may require that you see him/her for this referral. Referrals for Quebec patients are not required.

If you do not have a family physician, simply complete the following Online Registration form.

Please read all the information provided on this website. If anything is unclear, or if you think you would benefit from a telephone consult with Dr. Brulotte, please indicate so in the registration form below. Our office will contact you within 5 business days to book your vasectomy.