Vasectomy Consent Form (PDF) - Centre for Health - centreforhealth org 2025

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A consent form is a document that someone signs to show that they will allow something to happen. Consent forms are used in psychology to insure that a person is aware of what they are agreeing to do and of any risks or costs that may exist.
STATEMENT OF PERSON OBTAINING CONSENT To the best of my knowledge and belief the individual to be sterilized is at least 21 years old and appears mentally competent. He/She knowingly and voluntarily requested to be sterilized and appears to understand the nature and consequences of the procedure.
Consent by partner If, against a mans wishes, his wife is informed of and asked to consent to her husbands vasectomy, this can be regarded as a breach of medical confidentiality and an infringement of an individuals right to self-determination (i.e. autonomy).
Deciding to have sterilization surgery. A sterilization surgery is a procedure done to permanently prevent future pregnancies.
Specify Type of Operation consent expires 180 days from the date of my signature below.
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