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No-needle, no-scalpel vasectomy
Dr Stein technique

BOOKING AN APPOINTMENT

OTTAWA/GATINEAU

Ottawa Medical Group

  • Vasectomy: OHIP and RAMQ covered
  • Circumcision: 400$ (tax included)
  • Vasectomy reversal consultation: OHIP and RAMQ covered
  • Vasectomy reversal: 3000$ (tax included)

HAWKESBURY

Ruby Medical Center

  • Vasectomy: OHIP and RAMQ covered
  • Circumcision: 400$ (tax included)
  • Vasectomy reversal consultation: OHIP and RAMQ covered
  • Vasectomy reversal: 3000$ (tax included)

MONTREAL

REMD Solutions

  • Vasectomy: 495$ (tax included)
  • Circumcision: 420$ (tax included)
  • Vasectomy reversal consultation: 200$ (tax included)
  • Vasectomy reversal: 2800$ (tax included)

CONTACT ONE OF OUR CLINICS

CONTACT ONE OF OUR CLINICS

CHOOSE A SERVICE

PERSONAL INFORMATION

Personal Details

OCCUPATION


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.


Family

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?

Family

FAMILY HISTORY

Does your child have any family history of bleeding disorders (e.g., hemophilia)?

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?

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?

MEDICAL HISTORY

Has your child ever been diagnosed with any medical conditions such as bleeding disorders, hypospadias, or methemoglobinemia?

Does your child take any prescription medications (sulfonamides)?

Does your child take any non-prescription drugs (aspirin)?

Is your child allergic to any medications (e.g., lidocaine, prilocaine)?

Has your child ever undergone a surgery on the genital area?

Has your child ever been diagnosed with a blood transmitted disease including, but not limited to, AIDS?

CONSENT

Consent