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.NameThis field is for validation purposes and should be left unchanged.
