Patient Resources and Policies | Texas Vasectomy Center

Before your appointment

Forms to complete

Choose the section that matches how your appointment is scheduled. Forms may be completed electronically or printed and completed by hand.

Consultation only

Coming in for a consultation only

Complete these three documents before coming to the office:

Consultation + vasectomy

Coming in for the consultation and vasectomy on the same day

Complete these three documents:

Required before scheduling: Send all completed paperwork to becky@txvasectomy.com or fax it to (832) 753-4301. We must receive the paperwork before we can place a single-visit consultation and vasectomy on the schedule.

Payment is collected when the appointment is scheduled. We generally send the patient a secure Square payment link.

HIPAA Notice of Privacy Practices

Review how Texas Vasectomy Center may use and disclose protected health information and the rights patients have regarding that information.

HIPAA Notice of Privacy Practices (PDF)

Sending paperwork: Email completed forms to becky@txvasectomy.com or fax them to (832) 753-4301. Please do not send highly sensitive information in the body of an ordinary email.

Office policies

Appointment, cancellation, and payment policies

Standard vasectomy cancellation and rescheduling

Please give the office at least one week’s notice before the scheduled procedure if you need to cancel or reschedule. With at least one week’s notice, you may cancel or reschedule without consequences.

The office does not charge an immediate fee or penalty when less than one week’s notice is given. However, a $200 deposit is required before the patient can be placed back on the vasectomy schedule.

The $200 deposit is returned if the patient proceeds with the vasectomy at the rescheduled date and time.

Important: Once that deposit is placed and the patient is returned to the schedule, the new date and time cannot be changed again. Missing that appointment - including arriving more than 20 minutes late - causes the deposit to be forfeited, and the patient will not be placed back on the schedule again.

Standard Vasectomy Cancellation and Rescheduling Policy (PDF)

Single-visit consultation and vasectomy refund policy

When the consultation and vasectomy are scheduled together in one visit, the consultation fee is $220 and is paid outside insurance. The vasectomy charge is submitted to insurance, and the patient remains responsible for the amount applied by the plan.

The office collects the $220 consultation fee plus the patient’s estimated insurance responsibility for the vasectomy when the appointment is scheduled.

If the appointment is canceled or rescheduled more than seven days before the appointment date, the payment is refunded in full.

The payment becomes nonrefundable at the seven-day point.
Because a large block of time is reserved, single-visit consultation and vasectomy appointments cannot be rescheduled within seven days of the appointment.

Single-Visit Consultation and Vasectomy Refund Policy (PDF)

Insurance estimates and patient responsibility

The office contacts the patient’s insurance company to obtain an estimate before medical services are provided. Insurance companies sometimes provide inaccurate information or later deny payment despite an earlier benefit quote.

The insurance quote is therefore an estimate, not a guarantee.

Patients remain responsible for deductibles, copays, coinsurance, and any other balance that their insurance plan does not pay.

Questions about a policy? Call (832) 753-4300 before scheduling. A knowledgeable staff member can explain the terms before any deposit or payment is collected.

Accessibility

Accessible help is available

Texas Vasectomy Center is committed to providing access to its website information and patient materials for people with disabilities. If you have difficulty using this website or need a document in another format, call (832) 753-4300. A staff member will assist you.