For your convenience, the following forms can be printed and completed prior to your office visit.

• Quinacrine Sterilization Informed Consent - 9 Pages (139 kb)
  This file must be read and signed prior to having the QS procedure. It contains information regarding the process, follow-up procedures, effectiveness, risks, advantages, disadvantages, and more.
  
  
• Patient Physical & Medical History (21 kb)
  This file is a medical history form. You can fill out as much as possible and bring with you to your office visit.

These files are in a PDF (Portable Document Format) format and require Abode Acrobat Reader to open. If you do not have Acrobat Reader, click the button below to download a free copy.