Is a Vasectomy Right For You?

Are you and your partner certain that you do not want to have children/ more children?

Yes

No

Do you feel comfortable with the idea of a permanent form of contraception?

Yes

No

Would you prefer if your partner wasn't on a hormonal contraceptive pill or an IUD?

Yes

No

Would proven and trusted contraception improve your sex life?

Yes

No

Is the thought of experiencing an accidental pregnancy stressful to you?

Yes

No

Do you worry about getting your partner pregnant affect the quality of your erections?

Yes

No

Patient Name:(Required)

Patient Phone(Required)

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