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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.

42 Comments

Tina Reply

I am 47 years old and i would like to reverse my tubes. I and my husband would love to have a child together…


    Dr. Monteith Reply

    Tina
    It is harder to become pregnant with increasing age but not impossible if you are having regular periods. I would not delay your decision for too long.

    The chance of pregnancy after age 40 and tubal reversal is about 35% to 40%. We do have many patients who become pregnant with tubal reversal after age 40. Most of the women who become pregnant after reversal are between the age of 40 and 43.

    For more information: Tubal reversal and age

    The surgery at our center should be safe. Pregnancy should be safe as long as you dont have any severe medical conditions. It is harder to become pregnant with increasing age so I would not delay your decision for too long.

    To see more the success stories of older moms visit: Successful tubal reversal after age 40

    Here is a testimonial you may be interested in: “We Had Given Up” Tubal Reversal Mom Age 47

    Call us at (919) 977-5050 8am to 5pm eastern standard time and we would be happy to speak with you about tubal reversal at our center.

    The following link will answer most of your questions about reversal. This is the MOST HELPFUL INFORMATION to read when considering reversal at our office. Each question has a link to more information about the question: Frequently asked questions about tubal reversal


KATRINA Reply

I HAVE HAD TUBES BURNED AND CUT AND TIED, WHAT CAN STOP ME FROM GETTING THE REVERSAL DONE


    Dr. Monteith Reply

    We can reverse most tubal ligations. Ideally you should send us your tubal ligation operative report for a free review.

    Call us at (919) 977-5050 8am to 5pm eastern standard time and we would be happy to speak with you about tubal reversal at our facility.

    The following link will answer most of your questions about reversal. This is the MOST HELPFUL INFORMATION to read when considering reversal at our office. Each question has a link to more information about the question: Frequently asked questions about tubal reversal


L. Reply

What is the quickest someone has become pregnant after having reversal surgery? Does reversal surgery put you at risk for an ectopic pregnancy? What is the BMI restrictions for a tubal reversal? I am in the 29-32 BMI range, but do not have a huge abdomen. Thank you for your time.


    Dr. Monteith Reply

    We will email you more information.

    1. We have had many patients become pregnant the month after tubal reversal surgery. We advise our patients they can start trying to become pregnant as soon as they feel comfortable.
    2. Tubal reversal does increase the risk of ectopic pregnancy. The risk of ectopic pregnancy after reversal is about 10%.
    3. Our maximal BMI limit is 37.

    We charge $6400 total plus $125 to schedule and we are located in Raleigh, North Carolina. Insurance will not pay for tubal reversal surgery.

    You should send us your tubal ligation records for a free review.

    Patients pay in full and out-of-pocket at the time of scheduling. All you have to pay for in addition to the surgical fee is the cost of travel, hotel, and food. Patients stay in Raleigh a total of 2 nights and 3 days. The consultation is the first day, surgery the second day, and postoperative visit is the third day.

    We do have a prepayment tubal reversal plan that allows you to save towards your reversal over a 3 year period.

    Although $6,400 seems expensive…the alternative treatment in-vitro fertilization (IVF) average $12,000 to $14,000 and is about 40% successful!

    The main advantage to tubal reversal is that every month you have a chance and you can become pregnant more than once. On average, about 2 out of every 3 women become pregnant with tubal reversal surgery.

    Call us at (919) 977-5050 8am to 5pm eastern standard time and we would be happy to speak with you about reversal surgery at our center.

    The following link will answer most of your questions about reversal. This is the MOST HELPFUL INFORMATION to read when considering reversal at our office. Each question has a link to more information about the question: Frequently asked questions about tubal reversal


Yanira Reply

Hola …tengo 41 yrs old i have my tube tie sincer 2004 .. But i try get my record but i cant get it .. Can i still get my reversal tube ??? Plz let me know assp …


    Dr. Monteith Reply

    Yanira
    We can reverse most tubal ligations….even if you have no records!

    You should try to get your tubal ligation operative and pathology reports by going to the medical records department in the hospital where your tubal ligation was performed.

    You should be able to request a copy of your tubal ligation operative report and a copy of the pathology report (a pathology report is only created when a segment of the tube is removed (typical with tubal ligations that involve tying and cutting the tubes). We can review these records free of charge.

    You can personally request your record from the hospital where your tubal ligation was done using our Medical Records Release/Request form: Medical Records Release Form

    You dont have to have your records to have tubal reversal at our center. You should consider our optional screening laparoscopy if you cannot get your tubal ligation records. Many patients come to us for reversal without records because they know we can repair most tubal ligations.

    We charge $6,400 for tubal reversal surgery. Many women may not be able to obtain their records…some will have surgery because they know we can repair most tubal ligations. Others will add on a screening laparoscopy.

    If you choose to have a screening laparoscopy we can look with a camera during the surgery and see if your tubes are repairable. If your tubes are not repairable or then we would offer you a refund of your surgical fee.

    For more information: Screening laparoscopy and surgery refund

    For more information: Screening laparoscopy and scar tissue

    Call us at (919) 977-5050 8am to 5pm eastern standard time and we would be happy to speak with you.

    The following link will answer most of your questions about reversal. This is the MOST HELPFUL INFORMATION to read when considering reversal at our office. Each question has a link to more information about the question: Frequently asked questions about tubal reversal


Tanya Reply

How much is it to review my medical records to see if I’m a candidate for reversal? I had essure done in 2012.


    Dr. Monteith Reply

    We dont charge to review your records. Call us at (919) 968-4656 8am to 5pm eastern standard time and we would be happy to speak with you.

    The following link will answer most of your questions about reversal. This is the MOST HELPFUL INFORMATION to read when considering reversal at our office. Each question has a link to more information about the question: Frequently asked questions about tubal reversal