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(021) 437 4997 Register Now

Procedure
Before
After
About
Cost
FAQ
Contact

Registration Form

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What happens next: you choose your procedure date at the end of this form. Dr Foley will review the information you have provided, and if he feels you require a pre-operative consultation beforehand you will be contacted.

Cancellation policy: you will be charged €100 if you do not show up for your vasectomy appointment, or if you cancel less than 24 working hours before the scheduled time. Please call the clinic on 021 437 4997 to cancel.

1Personal Details

2Medical History

3Consent

4Appointment

Personal Details
Your name*
First Last
Address*
Address Line 1 Address Line 2 Town / City County Eircode Country
Date of Birth*
DD slash MM slash YYYY

DD/MM/YYYY
Mobile*
Email*
Emergency Contact Name*
Emergency Contact Number*
Name of GP*
GP Address*

Medical History
Please tick any of the following that are relevant to you:*
- Scrotal or groin surgery (please specify below)
- Any previous scrotal injury
- On blood thinning medication (including aspirin)
- Any bleeding disorder or a family history of bleeding disorders
- Pre-existing scrotal/testicular pain
- A fainting tendency if attending for minor medical procedures
- Diabetes
- None of the above
- Other (please describe below)
Please expand on your medical history eg Undescended Testicles/Childhood Hernia/Torsion of the testicle. Write 'None' if no relevant medical history.*
What is your approximate Height in cm?*
Please enter a number from 100 to 250.
What is your approximate Weight in Kg?*
Please enter a number from 30 to 300.
Please list the names and dosages of any regular medications that you are currently taking, prescribed or otherwise. Type 'None' if none.*
Have you any allergies or an allergy to latex?*
- Yes (please list below)
- No
Please list your allergies*

Consent
In order to proceed with being offered an appointment to undergo a Vasectomy you are required to consent to the following. All four are required.
I have read the information on the vasectomycork.ie website.*
I have read the information on the vasectomycork.ie website.
I acknowledge that there are risks to undergoing a vasectomy including the possibility that the procedure has a chance of early and late failure, scrotal haematoma, infection, post vasectomy pain syndrome, epididymitis and sperm granuloma.*
I acknowledge that there are risks to undergoing a vasectomy including the possibility that the procedure has a chance of early and late failure, scrotal haematoma, infection, post vasectomy pain syndrome, epididymitis and sperm granuloma.
I acknowledge that a vasectomy is considered a permanent form of contraception and that it may not be possible to have it reversed.*
I acknowledge that a vasectomy is considered a permanent form of contraception and that it may not be possible to have it reversed.
I consent to being contacted by Email/Phone number with the details I provided.*
I consent to being contacted by Email/Phone number with the details I provided.

Choose Your Procedure Date
Choose a date and time for your vasectomy with Dr Foley. All times are Irish time. Allow about an hour at the clinic on the day.
Available appointments

If no times suit you, submit the form anyway and we will contact you to arrange one.

Ready to Take the Next Step?

Register now for your no-scalpel vasectomy with Dr Foley at Owenabue Medical Centre, Carrigaline.

Register Now or call (021) 437 4997

Vasectomy Cork

Dr Vivian Foley provides safe, minimally invasive no-scalpel vasectomy procedures at Owenabue Medical Centre in Carrigaline, Co. Cork. All-inclusive pricing with comprehensive aftercare.

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☎ (021) 437 4997

✉ info@vasectomycork.ie

⚲ Owenabue Medical Centre, Ballea Road
Carrigaline
Co. Cork

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