Get Canada Gentle Procedures Clinic Vasectomy Referral 2022-2025

Filling out the Canada Gentle Procedures Clinic Vasectomy Referral is an important step towards obtaining a vasectomy. This guide will provide you with clear, step-by-step instructions to assist you in completing the form accurately and effectively.

Follow the steps to fill out your vasectomy referral form online.

1. Press the ‘Get Form’ button to access the vasectomy referral form and open it in your preferred editing tool.
2. Begin filling out the patient information section. Enter the patient's full name, date of birth (DOB), OHIP number, email address, and phone number in the designated fields.
3. Move on to the physician information section. Provide the physician's name, phone number, fax number, and OHIP billing number. Ensure all information is accurate to prevent processing delays.
4. In the 'Consult' section, clearly state the purpose of the referral by indicating that the patient seeks permanent sterilization through a vasectomy. You may also include that the patient is aware of alternative contraceptive options.
5. Fill out the past medical history section. Mark 'Healthy' if applicable or list any other medical conditions that the patient has. This information is critical for the reviewing physician.
6. Document any medications the patient is currently taking. If there are no prescription medications, indicate this clearly by stating 'None.'
7. List any allergies the patient may have. If there are no known allergies, write 'None.'
8. Ensure that the referral form has a signature line; the physician must provide their signature and title. This authorizes the referral to proceed.
9. After completing all sections, thoroughly review the form for any missing information. If any fields are incomplete, the referral will be returned.
10. Once the form is accurately filled out, you can save the changes, download a copy, print the form, or share it as needed.

Complete your vasectomy referral form online today to ensure a smooth and efficient process.