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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 Beverly Hills, Los Alamitos or Huntington Beach, 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.

(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.)