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TUBAL REVERSAL FORMS
FORMS TO COMPLETE FOR TUBAL LIGATION REVERSAL

These forms will help you provide us with important information.

Medical Records Release Form

Complete our Medical Records Release Form, print it out, and then fax or mail it to the Medical Records department of the hospital where you had your tubal ligation surgery.

Our Medical Records Release Form requests that the designated facility fax or mail your tubal ligation records directly to us along with the records release form. Without the form included, we will not have the necessary information in order to contact you to review your records.


Fax Cover Sheet

If you already have a copy of your tubal ligation records, please complete our Fax Cover Sheet, print it out and fax your records, along with the completed fax cover sheet to fax: (919) 883-4036. Without the completed fax cover sheet we will not have all the necessary information needed to be able to contact you after your records have been reviewed.

1. Medical Records Release

2. Fax Cover Sheet

3. Pre-Payment Form

4. Tubal Reversal Surgery Checklist

If you would rather scan and email your records to us then please email your records (with the Fax Cover sheet) to: ContactUs@tubal-reversal.net


Preparing For Tubal Reversal

After you have scheduled a date for your tubal reversal, please print out a copy of the Tubal Reversal Surgery Checklist to ensure your successful preparation for your reversal.

If you already have or would like to start a pre-payment account, complete the Pre-Payment Form, print it, and mail it with your payment each time you make a payment toward your account. See Fee and Financing for details about the pre-payment plan.


Pregnancy Report Form

We want to be informed as soon as you become pregnant after your tubal reversal. You can use the Pregnancy Report Form, or call or email us when you have a positive pregnancy test. An essential part of our long term care is follow-up with you and your local doctor during your pregnancy.


Birth Report Form

We are eager to hear when your baby is born. Please complete the Birth Report Form, or call or email us when you have a baby. Your comments are extremely important and provide both hope and inspiration for other couples. With your permission, we will add a page for your baby in the Testimonials section of our website.

Have Questions? We’re Happy To Help!

We provide a unique surgical experience with personalized attention and one-on-one care. We make every effort to make your surgery less of a process and more of a life’s experience. Please use the buttons below for answers to our frequently asked questions.

What Our Patients Are Saying

“We had our surgery on 3/18/15 and on 02/02/16 our 7 pound 11 oz baby girl was born! I’m 34 years old and had tubal ligation done via clamps 8 years prior so this surgery really does work! 8 years later I had the reversal and 9 years later we were blessed with our little girl! So many doctors tried to talk us out of it-wanted us to do IVF to get our money-however praise God we went with this because it does WORK! Dr M is amazing and his staff! The area is beautiful where his office is, and if you do this procedure it will be the best money you ever spend!”

– Charlee-Belle M., Surgery

“From the very first phone call, the staff at A Personal Choice has been amazing! They have answered our numerous questions, concerns and have been amazing. They never give you false hope, but give you the complete story. I am so happy that we chose Dr. Monteith and his staff to make our dreams a reality. Can’t wait to start trying to have a baby. I would and have recommended Dr. Monteith to ANYONE wanting a tubal ligation or vasectomy reversal. Thank you all so much for giving us this chance!”

– Angela W., Essure Reversal

“Excellent service overall! Each stage of the process was carefully explained in great detail: how the procedure works, what to expect during the procedure, what to expect after, possible side effects. Dr. Monteith himself is very knowledgeable and experienced and quite personable too. He has a great sense of humor and uses it generously to put patients at ease. I highly recommend him and his staff to anyone considering either a vasectomy or a vasectomy reversal.”

Chris B., Vasectomy Reversal

“The perfect little angel that I’m holding in my arms right now is the best testament to what Dr. Monteith and his staff do for people. We could not be happier with our decision to use Dr. Monteith. His staff are just amazing. Our entire experience was just a dream! Thank you, from the bottom of our hearts, thank you!”

Jamie B., Reversal of Cut & Tied Tubes

GET IN TOUCH WITH US

Ask The Doctor

Your questions about reversal surgery will be answered directly and promptly by Dr. Monteith. Please read our most frequently asked questions before submitting your questions. Dr. Monteith will not respond to general medical questions or if you are a patient of another doctor and are contacting him because your doctor is unavailable.* If you have been a patient at our reversal center and have specific questions about your medical care you should contact the reversal staff directly at (919) 977-5050.

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Have Questions? Leave a comment here or visit our contact page.

44 Comments

Zoila Reply

Quisiera que me ayuden para poder aserme la cirugía


    Dr. Monteith Reply

    Zoila
    Please call us next week at (919) 977-5050 and ask to speak with Oyuki or Karla. They speak Spanish and can help you.