The Best Life Microsurgery Clinic Consultation

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Consultation Questionnaire

It is mandatory, that you fill out this questionnaire fully before we could confirm the time slot for a remote or face-to-face consultation. Therefore please take care to provide answers to all questions. If you had previous reversals or IVF or any other medical problems, please provide full details.

(The expansions of abbreviations used in the following questionnaire: DOB - Date of Birth,   DM- Diabetes, IHD- Ischaemic Heart Disease such as Angina or Heart attack, HT- High blood pressure)

Click here to complete our detailed questionnaire

Booking  Your Personalised Consultation

Once you submit your questionnaire, you will see a message detailing the potential days over the next two weeks. Usually, the appointment will be given within a week. You will also receive an email. Please reply to the email about your convenient day over the next two weeks. 

Section 1

Section 2

Section 3 - Your current Partner Details:

Section 4 - Your medical history:

Section 5

Section 6

We will be discussing the following details during the consultation. If you have any specific queries or concerns please let us know.

Video Consultation

Many of our patients travel from different parts of the UK, Ireland and abroad and prior face-to-face consultation is not usually feasible for them. Therefore remote consultation is the norm for most of our patients.   Following the consultation, you will receive a detailed summary of what was discussed including the personalised chances of success, risks, alternatives and uncertainties. After this, you will be able to make a fully informed choice of if and when and where you would want to have your reversal. There is absolutely no obligation to book the procedure with us and this service is totally free. If you decide to have this consultation, please fill out the detailed questionnaire at the link below. It is mandatory to complete the questionnaire prior to the consultation. This will save time during the phone call and also ensure the accuracy of the information you are providing to us.


Face-to-Face Consultation

For those who would like to come for face-to-face consultation or those patients with complex history especially those patients who desire reversal for pain, we encourage them to come for a face-to-face consultation. This will give the surgeon the opportunity to check the length and quality of the remaining tubes and identify the potential challenges such as insufficient tubes, blowouts etc.  As Mr Jesuraj performs both Vaso-vasostomy and Vaso-epididymostomy, he is capable of dealing with these challenges and manages to complete the reversal on both sides on more than 97% of our patients. The cost of face-to-face consultation will be £240, though part of this will be reduced from the procedure cost if you go ahead with the procedure in our clinic. If you decide to have this consultation, please fill out the detailed questionnaire that is mandatory prior to the consultation. This will save time during the consultation and also ensure the accuracy of the information you are providing to us.


Contact us today  Tel:  01642 939798 
Text:  07984448243

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