Consents and Forms

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)

History and Registration form in Spanish (PDF)

Vasectomy Consent form, very general (PDF)

Vasectomy Consent form in English, very specific to practice of Dr. Doug Stein and Dr. John Curington (PDF). We include this so you can see an example of a very detailed consent. Choose your own style.

Vasectomy Consent form in Spanish, very specific to practice of Dr. Doug Stein and Dr. John Curington (PDF). We include this so you can see an example of a very detailed consent. Choose your own style.

Vasectomy Procedure Note, very general (PDF)

Vasectomy Procedure Note in Spanish, very general (PDF)

Vasectomy Procedure Note for Dr. Stein and Dr. Curington (PDF). This is specific to the physicians, and gives an example of a one-page complete op note.

Vasectomy Forms from Dr. Charles Wilson. This is an extensive collection of useful vasectomy forms, including consents, registration forms, after-care instructions, etc. Dr. Wilson is generously sharing these with the physician community. Physicians are welcome to use these as a reference point to write their own forms, though do remember that these are copyrighted.

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.