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Vasectomy Reversal Prepayment Account Scheduling Questionnaire

Vasectomy Reversal Prepayment Account
Scheduling Questionnaire

The Vasectomy Reversal Prepayment Account Prescheduling Questionnaire can be found at the bottom of this page.

If you are having problems completing 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 questionnaire and the nurse interview, you can then start your Reversal Prepayment Account with greater confidence you will be a good candidate for tubal surgery. You will also be in a better position to more quickly take advantage of any reduced rate surgeries should they become available.

  1. Please complete and submit this Reversal Prescheduling Questionnaire before paying your scheduling fee.
  2. 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.
  3. Please call at any time if you have questions.
  4. A nurse will only call you to conduct your health interview after your questionnaire has been completed, you have paid the scheduling fee, and we receive email confirmation your scheduling fee has been paid.
  5. 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. Phone interviews do not occur on weekends or after 5 pm East Coast time.

After completing this questionnaire and the nurse phone interview, you can then send in your initial contribution. This prescheduling process will allow you to save towards your surgery with greater confidence you will be the best candidate possible when you are ready to schedule. Since you have obtained medical clearance, you will also be able to more quickly take advantage of any reduced surgery rates should they become available.

Reduced rates will only be offered to Reversal Prepayment Account members.

Vasectomy Reversal Prepayment Account Surgery Scheduling

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


hortencia hernandez Reply

muchas gracias espero si les llego el ya llene elcuestonario y

    Dr. Monteith Reply

    What information did you send..please call us at (919)977-5050 to talk. You can ask for Oyuki or Karla. They speak Spanish and can help you.

      Santana Locklear

      Hey is this a payment plan? Where I put $500 on it or do it have to be paid at once?

      Dr. Monteith

      We have two flexible payment options for you if you dont want to pay in full for surgery:

      (1) start a prepayment plan with us
      (2) finance your reversal surgery.

      To better understand scheduling surgery we encourage you to watch this video: Tubal Reversal Surgery: The Process

      Prepayment plan. We do have a prepayment plan that allows you to save towards your surgery. You need to start it with at least $500 and you can contribute any amount over the next 3 years. When you have saved the full amount then you can have your surgery. You can have the surgery anytime within 3 years of starting your plan.

      If you dont have your surgery by the end of the third you you are refunded all of your money less $500. Surgery discounts, when available, are offered to prepayment account members only.

      For more information: Tubal Reversal Prepayment Plan

      Financing reversal surgery. We work with two companies who will help you finance surgery. You would apply for financing directly with United Medical Credit. The link to their company and the application for financing is on our website.

      For more information: Financing Reversal Surgery

      We charge $6,900 total for tubal ligation reversal and $7,900 for Essure reversal plus $150 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 $6,900 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.

      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

      If you have any questions call our office at (919) 977-5050.

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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