One of the challenges in starting a vasectomy practice is writing the various forms you will need. Below we have examples of patient history forms, consents, operative notes, post-op instructions, etc. Feel free to modify these to suit your own practice.
History and registration form in English
(PDF format)
History and registration form in Spanish
(PDF format)
Vasectomy Consent Form
(PDF format)
Vasectomy Procedure Note
in English
(PDF format)
Vasectomy Procedure Note
in Spanish
(PDF format)
Vasectomy Procedure Note
for Dr. Stein and Dr. Curington. This is very specific to the physicians, and gives and example of a one-page complete op note. (PDF format)
Vasectomy Patient Information Worksheet (PDF). This form helps an assistant do very complete counseling. If an assistant just marches down the checklist and uses the diagrams, they will have done a thorough job in counseling.
Instructions for after vasectomy (PDF). A very generalized post-op instruction sheet.
Instructions for after vasectomy in (in website format). This is a link to aftercare instructions that we send by text to patients after a vasectomy. Many patients enjoy reading the instructions on their phones or tablets, and if they loose their paper instructions, it’s easy for us to send a link to the online version. Click here for English, here for Spanish, here for Portuguese.