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.