Circumcision Clinic Hamilton, Ontario
Main Menu
Book Online

Adult Circumcision Registration

Contact Us

Gentle Procedures Clinic does not offer circumcision for medical reasons. We provide circumcision solely for cosmetic, religious, personal hygiene, cultural reasons, and personal preferences. Those potentially seeking circumcision due to medical concerns should contact their family doctor.

Please complete the registration form below for adult circumcision.

We will reply to confirm your appointment (if not already scheduled) and answer your questions.

Thanks for booking with us.

"*" indicates required fields

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

Patient Information

Name*
DD slash MM slash YYYY
Address*
Reason for consultation*
Emergency Contact Name*
Family Doctor
How did you hear about us?*

Allergies

Do you have any allergies?*

Medical History

Do you have a history of easy bruising?*
Do you have nosebleeds with little or no trauma?*
Have you ever had abnormal or prolonged bleeding after a dental procedure?*
Did you have any medical or bleeding problems, or blood loss, since birth?*
Does your family have any history of bleeding problems?*
Do you have any reason to believe that you have low blood pressure or low hemoglobin?*
Have you ever experienced fainting after an injection or medical procedure?*
Have you ever been bothered by a tight band on the underside of your penis that causes pain or bleeding during sex?*
(name/dosage)

Appointment

Do you already have your appointment booked?*