Registration Form

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Vasectomy Registration Form

Please fill our registration form to book a procedure. On submission we will send you an email with a link to book an appointment time.
  • Street Address*
    Address Line 2
    City*
    State / Province / Region*
    Zip / Post Code
    Country*
  • DD
    /
    MM
    /
    YYYY
  •  
  •  
  • First Name
    Last Name
  •  
  • Street Address
    Address Line 2
    City
    State / Province / Region
    Zip / Post Code
    Country
  • Medical History
    • Please tick any of the following that are relevant to you:
    • Please expand on your medical history eg Undescended Testicles/Childhood Hernia/Torsion of the testicle. Write 'None' if no relevant medical history.
    • Please list the names and dosages of any regular medications that you are currently taking, prescribed or otherwise. Type 'None' if none.
  • Family Information

BOOKINGS ARE OPEN FOR PRIVATE VASECTOMY PATIENTS. 

 

VASECTOMY PROCEDURES COVERED BY MEDICAL CARD ARE CLOSED FOR 2025 

 

PLEASE NOTE : THE VASECTOMY PROCEDURE IS COVERED BY YOUR MEDICAL CARD. DO NOT REGISTER HERE. PLEASE CONTACT RECEPTION BY PHONE TO ARRANGE AN APPOINTMENT FOR 2026 Please have your current medical card details available.

Cancellation Policy: We require 48 hrs notice for cancellation of appoints. Failure to do so may incur a fee of €250.

Vasectomy Cork,
Ballea Rd. Carrigaline,
Co. Cork

Phone: (021) 437 4997