For prospective patients located within the United States, please call (972) 996-7177 to schedule your free Vasectomy Reversal Phone consult with Dr. Buch or contact us online.
For prospective patients located in Alaska, Hawaii or outside of the United States, please print the form below and email it back to us at
info@vasectomyreversal.com. We will contact you as soon as your form is reviewed by Dr. Buch.
Please choose from the following formats.
Vasectomy Reversal Questionnaire - Coming soon...
NOTE: The above document was created in Microsoft Word and requires Microsoft Word to open, edit and print.
Vasectomy Reversal Questionnaire - Coming soon...
NOTE: The above document is stored in a pdf format, and requires the Adobe Acrobat Reader (version 4.0 or higher) to open or print. The Reader application may be downloaded without charge from the
Adobe Web site.
Patient Registration Form - Coming soon...
NOTE: For your convenience, you may print and complete our Patient Registration Forms above prior to your scheduled appointment. You may submit the completed forms, along with any attachment, before your office visit. Please note that we will also need legible copies of the front and back sides of your current insurance card (if applicable). Feel free to contact our office should you have any questions. Thank you and we look forward to helping you.