1-866-882-2573

New Patient Forms

Requesting Records:

The physician determines your candidacy for surgery based on the history you provide in addition to review of your medical records.

Your records can be helpful in providing information about the type of tubal ligation that was performed, anything additionally noted during the surgery and possibly tube length.

Remember to request both the Operative Report and Pathology Report from the hospital where your tubal ligation was performed.

Or Upload your files HERE

Tubal Reversal Surgery Forms:

Please print, sign and return forms to fax (727) 796-8764, attention – Sam:

Call us now at 1-866-882-2573 (1-866 – TUBAL REVERSAL) or email using our Contact Us Form and let us help your dream of a baby come true.