Vasectomy Questionnaire

I can confirm that I have read and understood all of the information given above *

I understand that a vasectomy should be considered to be an irreversible procedure and that if a reversal is requested this will not necessarily be successful and is unlikely to be available on the NHS *

I understand the risks associated with the procedure listed above including, but not limited to, the fact that up to 5% of men have long-term pain after the procedure and that the procedure has a failure rate of 1 in 2000 *

Do you have any further questions about the procedure that you feel have not been covered above? *

Taking all of the above in to account, would you like The Westgate Practice to refer you to the local Vasectomy Clinic? *