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Tubal Reversal Scheduling Questionnaire

Tubal Surgery
Scheduling Questionnaire

The Tubal Surgery Scheduling Questionnaire can be found at the bottom of this page.

If you are having problems competing this form on-line we can email this form to you or you can by-pass this completely and schedule by phone directly with the nurse.

By completing this surgery scheduling questionnaire your health interview and surgery scheduling with the reversal nurse will be more efficient.

Instructions On Completing The Questionnaire

  1. Submit this Reversal Surgery Scheduling Questionnaire before paying your scheduling fee.
  2. Provide the contact information for your nearest lab so the scheduling nurse may fax a lab order for any required lab testing. You can use any local lab but we encourage you to consider LabCorp. Their website ( will help you find the lab nearest you. The nurse will need the name of the lab and the phone and fax numbers for the lab.
  3. We recommend you follow-up with your local physician within 4 weeks of surgery.
    Only provide the contact information of the doctor you will see after surgery.
  4. If you do not have all of the information requested in this questionnaire you are welcome to skip those sections. You can provide the required information to the nurse at the time of your phone scheduling.
  5. Please call at any time if you have questions.
  6. After you submit this form and pay your scheduling fee, a Scheduling nurse will call you within 1 to 2 business days to schedule your surgery. Surgery scheduling does not occur on weekends or after 5 pm East Coast time.
  7. A nurse will only call you after your questionnaire has been submitted, you have paid the scheduling fee, and we receive email confirmation your scheduling fee has been paid.
  8. Available surgery dates change frequently. Your surgery date can only be confirmed after you have completed the phone scheduling and your full surgery payment has been received.
  9. If you are financing any portion of the surgery you will need to know the amount of financing you qualify for before you start the scheduling process.

Get Started With Surgery Scheduling

Have a Question? Drop Us A Line!

If you are considering reversal surgery and have questions about the procedure, fill in the form below and we'll get back to you as soon as we can! If you would like to speak with a nurse for a Free Consultation then feel free to call us at (919) 977-5050.

Please view our most frequently asked questions before sending your questions.

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