Book Your Vasectomy

Complete the below booking form and one of our team will be in touch within the next working day to confirm your appointment location, date, and time.

"*" indicates required fields

Snip clinic location*

This field is hidden when viewing the form

Auckland Avondale - Booking date*

Auckland Central - Booking date*

Auckland Manukau - Booking date*

Auckland Remuera - Booking date*

Auckland Takapuna - Booking date*

Christchurch - Booking date*

Dunedin - Booking date*

This field is hidden when viewing the form

Gisborne - Booking date*

Hamilton - Booking date*

Invercargill - Booking date*

Lower Hutt - Booking date*

Masterton - Booking date*

Napier - Booking date*

Nelson - Booking date*

New Plymouth - Booking date*

Palmerston North - Booking date*

Queenstown - Booking date*

Rotorua - Booking date*

Tauranga - Booking date*

Wellington - Booking date*

Whangarei - Booking date*

Preferred time*

Full Legal Name*

First Name Last Name

Date of Birth*

Age*

What is your ethnicity?*

Choose which applies to you*

Phone Number*

Email Address*

Street Address*

Street Address Suburb Town/City Postcode

Are you registered with a Medical Centre?*

Name of Medical Centre*

General Practitioner Name

The Ministry of Health is collecting stats on vasectomies. Would you be up for answering 3 quick questions?*

Relationship status*

Number of Children*

Reason for getting a vasectomy?*

Please provide further information for your reason to get a vasectomy*

This field is hidden when viewing the form

Is your partner currently pregnant?*

Would you like to book a phone appointment with a nurse before your Snip to discuss the procedure and any other questions you have?*

Do you take any of the following medications?*

Anabolic steroids

Aspirin

Blood thinners

Immunosuppressants

Oral steroids

Testosterone therapy

I do not take any of the above medication

Do you have any of the following medical conditions?*

Diabetes

Bleeding disorders

Heart disease

ICD/Pacemaker

I don't have any of the above medical conditions

Are you allergic to any medication?*

What medication are you allergic to?*

Would you like to take additional medication to help you feel calmer?*

Temazepam is an oral tablet taken shortly before your procedure while Penthrox is a fast-acting inhaler (green whistle) used during your procedure. Learn more about these medications on our Managing Anxiety page

Yes - I would like additional medication

No - I don't need additional medication

What additional medication would you like?*

Temazepam only - $35 (Note: Additional script dispensing fee will apply)

Penthrox only - $295

Both Temazepam & Penthrox - $330 (Note: Additional script dispensing fee will apply for Temazepam)

Since you’ve chosen Penthrox, you’ll need to have a quick chat with one of our nurses before your Snip. We’ll set up a phone appointment so they can walk you through a few important details.

Pharmacy Details*

Please provide your pharmacy name, address and phone number

Do you hold a Community Services Card?*

Card Number*

Expiry Date*

Have you had any groin injuries or groin surgery?*

For example: vasectomy reversal, twisted testicles, hydrocele, inguinal hernia

Details of groin injury or groin surgery*

Based on what you've shared, it seems you'll need to speak with one of our nurses before your Snip. We'll set up a phone appointment for you, so the nurse can give you some specific information and share anything important with the doctor.

This field is hidden when viewing the form

Archived

This field is hidden when viewing the form

Archived

This field is hidden when viewing the form

Card Number

This field is hidden when viewing the form

Please select any other ethnicities you identify with (3)

This field is hidden when viewing the form

Please select any other ethnicities you identify with (4)

This field is hidden when viewing the form

Please select any other ethnicities you identify with (5)

Do you have health insurance and who is your insurance provider?*

Unfortunately, we are not partnered with your insurance company. Please contact them directly to check if your policy covers vasectomy. If it does, you can submit an insurance claim to your provider after your procedure.

Do you need a quote from us for your WINZ application?*

Would you prefer to pay now or pay on the day?*

Pay now

Pay on the day

Your vasectomy fee to pay on the day will be $595.
If you have chosen to take extra medication: Temazepam is an additional $35 and Penthrox an additional $295.

Vasectomy Fee*

Price:

Vasectomy Fee*

including Temazepam ($35)

Price:

Vasectomy Fee*

including Penthrox ($295)

Price:

Vasectomy Fee*

including Temazepam & Penthrox ($330)

Price:

Message

I understand the effects testosterone therapy has on the ability to confirm infertility at the 3-month clearance test*

I have read the information about What if I am on testosterone? and I understand the effects of testosterone therapy

I have read and agree to Terms & Conditions*

I agree

Click here to see Terms

Book Your Vasectomy

Ready to take the next step?