NEW PATIENT REGISTRATION AND VASECTOMY FORMS

Ready for your No Needle No Scalpel Vasectomy?

You have probably been thinking about having a vasectomy for some time. You have discussed it with your wife or significant other, have done your research, and investigated the best center and urologist to perform your No Needle No Scalpel Vasectomy.

Well, you are almost ready. Follow these simple steps:

1. Call toll-free 844-EASY VAS (844-327-9827) to schedule your initial consultation/counseling with Dr. Robert Pugach, in his Los Alamitos CA office.
2. Download the New Patient Registration and Information package (PDF). Complete and bring with you for your first consultation/initial vasectomy examination and counseling visit:
   1. HMO patient – If you are an HMO patient and are associated with one of our participating medical groups, DOWNLOAD THIS FORM.
   2. PPO and cash patients – If you are a PPO patient or paying cash, DOWNLOAD THIS FORM.
3. Read the State mandated vasectomy consent form. During your initial visit with Dr. Pugach we will review the form with and obtain your signature.
   You are required to wait a minimum of 72 hours prior to receiving your vasectomy:
   1. State of California Vasectomy Consent Form (English)
   2. State of California Vasectomy Consent Form (Spanish)
4. Schedule your No Needle No Scalpel Vasectomy at our Los Alamitos or Beverly Hills office. The procedure will take 15 minutes and you are on your way!

(Please read our payment policies for your financial responsibility. If you require assistance with verifying or understanding your health plan vasectomy benefit and any associated co-pays or deductibles, we are happy to help.)