By booking a Vasectomy and attending my appointment, I Authorise Vasectomy.ie To perform a Vasectomy procedure, which consists of the surgical occlusion of a segment of the vas deferens
(the tube that conveys sperm from the testicle to the outside). Other methods of treatment, including the option of not having the procedure done, have been discussed with me, and I have chosen this method of contraception.

I understand the following:

That the purpose of a vasectomy is to make me permanently sterile.
That while the procedure is generally safe and very effective, there is no guarantee that sterility will be obtained (sterility is either not obtained, or fertility returns in approximately one case in five hundred).
That possible complications include, but are not limited to: pain, swelling, possible psychological effects on my sex life, bleeding or bruising, infection, allergy to local anaesthetic, failure to achieve permanent sterilization, or that the vas deferens may grow back together in the first few months or later.

I understand that I must continue to use contraceptives until sterility is confirmed by one sperm count at 16 weeks after the procedure. I have had the opportunity to ask questions and have had them answered. In addition, I have read this form and it has been explained to me in clear terminology. I understand the risks and intend to have the procedure done.