Chapel Hill Tubal Reversal Center
109 Conner Drive Suite 2200, Chapel Hill, NC 27514 (919) 968-4656

Medical Records Release Form

How To Obtain Your Tubal Ligation Operative Report

Please fill in your information and then press "Submit"

* The date of your tubal ligation was:
* Your name at the time of the tubal ligation was:
* Name of hospital or doctor's office:
* Your current name is:
* Your date of birth is:
* Your social security number is:
* Your current address:
  Address line 2:
* City
* State
* Zip Code
* Your home phone:
  Your work phone:
  Your cell phone:
* Your email address:
  (If you do not have an email address type "None")

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Special Report

Answers to seven important questions to find out if tubal reversal is right for you.

Telephone 919 968-4656 to speak with a Tubal Ligation Reversal Nurse

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(919) 968-4656

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Website updated November 7th, 2009 Chapel Hill Tubal Reversal Center logo©
Chapel Hill Tubal Reversal Center
109 Conner Drive Suite 2200, Chapel Hill, NC 27514 (919) 968-4656    Tubal Reversal News


http://www.tubal-reversal.net/tubal_ligation_operative_report.htm  was last modified on May 21st, 2009 21:54:52

Chapel Hill Tubal Reversal Center.
109 Conner Drive Suite 2200, Chapel Hill, NC 27514
Tel: (919) 968-4656     Fax: (919) 869-1976