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Private Vasectomy Booking Form

For MSP vasectomies, please fax all referrals to 778 627 2832.

First Name

Surname

Date of Birth

Address

City

Province

Postal Code

Phone number

Do you have a Family Doctor?

Yes No

If yes, please include their full name so we can send them a letter post-procedure:

Do you have any medical issues?

List of medications you are currently taking:

Do you have any children?

Yes No

Occupation

How did you hear about Dr. Fay Vasectomy?

A $200 deposit is required to book. This is deducted from the procedure introductory price of $999 + tax paid by patient. Failure to cancel or reschedule within seven days prior to the procedure date will result in loss of your deposit.

After you have submitted your booking form, Zen Medical will contact you via phone to book your procedure.

Our Clinic

Address

Zen Medical

2424 St Johns St.
Port Moody, BC V3H 2B1

Contact us

For MSP vasectomies, please fax all referrals to 778 627 2832.

For private vasectomies, please book here

Phone: 604 937 6077

Email: vasectomy@zenmedcare.ca

Take the Next Step

Book your vasectomy today for a quick, safe, and effective procedure with minimal downtime. Choose the option that works best for you and secure your appointment now.

Take the Next Step

Book your vasectomy today for a quick, safe, and effective procedure with minimal downtime. Choose the option that works best for you and secure your appointment now.

Address
Zen Medical 2424 St Johns St
Port Moody, BC V3H 1B1
Phone: 604 937 6077
Fax: 778 627 2832

Email: vasectomy@zenmedcare.ca

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