Post-Vasectomy Mail-In Kit (Form Test)Dr. Landon Trost2024-02-07T16:26:58-07:00 Post-vasectomy Mail-in Kit Online order form for patients who received a mail-in kit from their vasectomy provider. First name(Required) Last name(Required) Birthdate (mm/dd/yyyy)(Required) MM slash DD slash YYYY Phone number(Required)Email address(Required)Confirmation and results will be sent here What was the date of your vasectomy? (mm/dd/yyyy)(Required) MM slash DD slash YYYY Send results to your vasectomy clinician?(Required) Yes, I DO want my clinician to receive results (complete contact info below)) No, do NOT send results to my clinician Vasectomy providerPlease provide the name of the clinician and/or the office where the procedure was performed. Fax number of vasectomy clinicThis information is required if you want your clinician to receive results from your test. If our team has their information on file, they will automatically receive your results.Approximately how many times have you ejaculated since the vasectomy?(Required) Fewer than 15 times 15-30 times 30-45 times More than 45 times CommentsThis field is for validation purposes and should be left unchanged.