Post-Vasectomy Mail-In Kit (Form Test)Dr. Landon Trost2024-02-07T16:26:58-07:00 Post-vasectomy Mail-in Kit Online order form for patients who received a mail-in kit from their vasectomy provider. First name(Required)Last name(Required)Birthdate (mm/dd/yyyy)(Required) MM slash DD slash YYYY Phone number(Required)Email address(Required)Shipping label and results will be sent here - must match email used during checkout What was the date of your vasectomy? (mm/dd/yyyy)(Required) MM slash DD slash YYYY Approximately how many times have you ejaculated since the vasectomy?(Required)Send results to your vasectomy clinician?(Required) Yes, I DO want my clinician to receive results No, do NOT send results to my clinician Vasectomy provider(Required)Please provide the name of the clinician and/or the office where the procedure was performed.Fax number of vasectomy clinic(Required)This information is required if you want your clinician to receive results from your test.X/TwitterThis field is for validation purposes and should be left unchanged.
