Suite 207, 1015 Regent Street, Fredericton, NB E3B 6H5
Fredericton Urology Clinic
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UROLOGIC ONCOLOGY
GENERAL UROLOGY
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PROSTATE CANCER SCREENING
VASECTOMY SELF REFERRAL
VASECTOMY REVERSAL
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Prostate Cancer Screening Self Referral
Full Name
Medicare Number
Street Address
City
Phone
Postal / Zip code
Birthday
Email
Do you have a family doctor?
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Specific location where you want to get your bloodwork done
Do you have a family history of prostate cancer (father/brother)?
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Describe significant symptoms. If you do not have symptoms, write "none".
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. If you have concerns about confidentiality and prefer to provide information by phone, please call 506-458-0310.