Baby Circumcision Registration

Please complete the registration form below for baby circumcision.

We will call you back to confirm your appointment and answer your questions.

Thanks for booking with us.

  • Child Information

  • DD slash MM slash YYYY
  • Parent Information

  • Medical History

  • Type n/a if none
  • Type n/a if none. Please note that if the mother is taking any form of blood thinner (Dalteparin, ASA) you will need to call the office to speak with one of our doctors prior to your appointment.
  • Allergies

  • Referral Contacts - Optional

  • Circumcision Consent

    You must consent to the following:
  • This field is for validation purposes and should be left unchanged.

Gentle Procedures Perth is now open and performing procedures, and is strictly following public health guidelines when patients attend the clinic.

Patients may be accompanied by no more than two caregivers.

Please read our COVID-19 Information Page