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Fertility
Vasectomy
For Physicians
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Choose My Test
Fertility
Vasectomy
For Physicians
Resources
Choose My Test
Name
*
First
Last
Date of Birth
*
MM slash DD slash YYYY
Date of Vasectomy
*
MM slash DD slash YYYY
Email
*
Phone
*
Physician Instructions
If the fields do NOT autopopulate, please refer to the bottom of your HOME TESTING PROGRAM form to complete below.
Clinic Name
*
Physician Name
*
Test #1
6 weeks
8 weeks
12 weeks
Test #2
12 weeks
14 weeks
16 weeks
Annual Testing Recommended?
Yes
No
Optional
Your first test will be on:
MM slash DD slash YYYY
Your second test will be on:
MM slash DD slash YYYY
We'll send you reminders to help you remember when to take your SpermCheck tests.
SMS Consent
*
By submitting this form, you consent to receive informational messages (e.g., order updates), testing reminders, and other marketing messages from SpermCheck. Msg & data rates may apply. Msg frequency varies. Unsubscribe at any time by replying STOP or clicking the unsubscribe link in any email.
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