Loddie F. Roeder, Jr., M.D.

Microsurgical Vasectomy Reversals

FORMS


Please Print Out the Following Three Forms
Complete each Form, Sign, Date, and Mail, E-mail or Fax them to the office


FORM 1  PATIENT INFORMATION SHEET
FORM 2 NOTICE AND ACKNOWLEDGEMENT OF PRIVACY PRACTICES
FORM 3 INFORMED CONSENT