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Tubal Reversal Patient Registration Forms

If you require any assistance in getting started, please call our office at 866-790-0095 and we’d be very happy to assist you.

Tubal Reversal – Getting Started

Dr. Rosenfeld will review all medical records and the operative report from your tubal ligation surgery to determine if you are a candidate for the tubal reversal surgery. Please complete these steps to prepare for your tubal ligation reversal office visit:

Step 1:

Complete the operative report request.  Print and send this completed form to the doctor or hospital where your tubal ligation surgery was performed.

Step 2:

Complete online registration  to begin the process and to make your appointment for your office visit for evaluation for tubal reversal surgery.

Step 3:

Dr. Rosenfeld and the nursing staff will review all medical records to determine if you are a candidate for tubal reversal surgery.  Once it is determined that you are a candidate for the tubal reversal surgery, our staff will arrange your appointments and answer any questions about next steps, accommodations for out-of-town patients, or costs.