Forms

For your convenience the offices of Ted Benderev, MD and Robert Pugach, MD patient registration forms are provided below. Download the New Patient Registration and Information package (PDF). Complete and bring with you for your first consultation/initial vasectomy examination and counseling visit.

Vasectomy Doc Office Of Ted Benderev, MD

Dr. Benderev Patient Forms*

Call, Meegan for more information:  888-827-3286*

Vasectomy Doc Office  Of Robert Pugach, MD

Registration Packet for PPO and Cash Patients*

Vasectomy Consent Form – English

Vasectomy Consent Form – Spanish

Call, Kim for more information:  844-327-9827

*Note: If you have an HMO health insurance plan, please call our offices to verify if we can accept your insurance.

 

Multiple office locations for residents of Los Angeles, Orange, Riverside San Diego and Ventura Counties.
Limited late hours and Saturday appointments also available.
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Why Would You Go Anywhere Else?®

Meet The Docs

Ted Benderev, M.D., & Robert Pugach, M.D., Founders of Vasectomy Docs.
(Run time 3:37)

Gold Standard Vasectomy

No-Needle No-Scalpel, 15 minutes...
No Kidding!
(Run time 5:25)

Why Go Anywhere Else?®

Quality standards, 100% money back guarantee, cash pricing....
(Run time 37 secs)

Vasectomy Doc Offices

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