Step 1

Patient registration

This information will be reviewed by an authorised clinician. Submitting it does not guarantee eligibility or book a procedure.

Patient information package

Read about eligibility, preparation, recovery, semen testing and fees before continuing. Read the package (opens a new tab).

I have read the patient information package, version 2026-09-05.2. I understand I can ask questions and that this acknowledgment is not consent to surgery.

Identity and contact

Full name as shown on ID*

Email address*

Mobile number with country code*

Town or city*

Country*

Age in completed years*

Minimum age for vasectomy registration: 21 years.

Number of children

Relationship or marital status

How did you hear about Wispivas?

Clinical background

Give brief, accurate information. A clinician will confirm it privately.

Medication or drug allergies

Current medicines or supplements

Previous scrotal, testicular, groin or other relevant operations

Relevant medical conditions

Expected funding source

Do not use this form for urgent symptoms. Contact a healthcare facility directly if you need urgent care.

I have read the privacy notice and agree that Wispivas may process my contact and health information to arrange care, maintain the clinical record, conduct follow-up and support service quality.

Information is available only to authorised staff.

Patient registration

Patient information package

Identity and contact

Clinical background

Vasectomy fee and payment

How to pay