No-needle, no-scalpel vasectomy
Dr Stein technique



Asclepios Medical Clinic

For the Orléans clinic the procedure is covered by OHIP and RAMQ. You may also meet with Dr Brulotte.


REMD Solutions Inc.

For the Montreal clinic fees of $ 450 (taxes included) are applicable, which include consultation fees, procedure and equipment. Most insurance cover the procedure and different payment methods are available (cash, credit, debit).


Ruby Medical Center

For the Hawkesbury clinic the procedure is covered by OHIP and RAMQ


Personal Information

Contact Information

Preferred Phone


Level of exertion at work

Physician Information

If the doctor who referred you is not your family doctor, please write the name of your usual family physician.


Marital Status
If you have a partner, is she aware that you are taking an appointment for a vasectomy?
My partner is pregnant.
What method of birth control are you using now?

Medical History

Have you ever been diagnosed with any medical conditions?

Do you take prescription medications?

Do you take non-prescription drugs (aspirin)?

Are you allergic to any medications?

Do you have any bleeding problems?

Have you ever fainted or do you get queasy/faint with medical things like a blood test?

Have you ever had surgery to the scrotum or testicles including, but not limited to vasectomy, undescended testicles, torsion of the testicles, hydrocoele, varicocoele, hernia repair in childhood, tumor/cyst,growth in the scrotum or removal of a testicle?

Have you ever had genital herpes or genital warts?

Have you ever had a disease that can be transmitted by blood including, but not limited to, hepatitis or AIDS?

Have you ever had pain in the scrotum due to epididymitis or other cause?


How did you find us?
I have read and understand the four steps in family planning for this site.
I know I must avoid aspirin, ASA, or any products containing this for 7 days pre-operatively.
I am aware of the restrictions on physical activity for the week following the vasectomy