Online Appointment Request Form

You may submit the following form at any time to request an appointment. 

You may expect a call within one business day, (usually the same day) to set a final appointment time that is convenient for you. 

For  more immediate assistance, please phone our office:
1-888-VASECTOMY (1-888-827-3286) during regular business hours.

Online Appointment Request Form

Please call me regarding: (check one)

an In-Person consultation for No-Needle, No-Scalpel Vasectomy
an On-Line (Virtual) consultation for No-Needle, No Scalpel Vasectomy
Vasectomy reversal

  * = Required
* Your Name:
Address Line 1:  
Address Line 2:
* City:  
State:        Zip:  
* Telephone:   (best number to call you)
Leave a message by Can Message be left by Voice Mail?
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Can Message be sent by Email?
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Site content copyright © 1999-2017 Theodore V. Benderev, M.D. All Rights Reserved. 1-888-VASECTOMY (888-827-3286)

The content of this site is provided for information only and not for medical advice.  This site makes no claims as to the accuracy of its information and is not a substitute for direct consultation with your health care professional.

Dr. Ted Benderev is a well known urologist since 1990 who has performed more than 6,000 vasectomy and vasectomy reversal procedures. His practice is conveniently located in the Orange County communities including Aliso Viejo, Anaheim, Costa Mesa, Corona, Fountain Valley, Fullerton, Huntington Beach, Irvine, Ladera Ranch, Laguna Hills, Laguna Niguel, Mission Viejo, Newport Beach, Orange, Rancho Santa Margarita, San Juan Capistrano, Santa Ana, San Clemente, Tustin, Westminster, and adjacent counties of Riverside, San Diego and Los Angeles.