Islamic Circumcision Centre

Baby And Teen Age Consent Form

Patient Details
Guardian Details

I agree to the collection and use of my personal information above to aid in my treatment and for the purposes of appointment reminders so that we can be fair in allocating appointments to others, if you need to reschedule your appointment give us at least 24 hours notice.

Patient Medical Information
Emergency Contact
Method of Circumcision

Mogen Clamp Technique
The penis is sanitized then locally numbed. The mogen clamp is placed over the head of the penis. The foreskin is removed using steriled tools.

  • Pain
  • Bleeding
  • Infection
  • Irritation on the tip of the penis
  • Meatitis
  • Improved genital hygiene
  • Reduced risk of urinary tract infections
  • Reduced risk of phimosis after circumcision
  • Reduced risk of HIV/AIDS
  • Serious complications requiring hospitalisation are rare (approximately 1 in 5000)
  • The need for repeat surgery is not common at less than 1 in 1000
Post Operative Instructions

On the procedure day, Mr El Masri will provide you with care instructions and follow-up visits. A flyer will also be provided on the day outlining the step-by-step after care for your circumcision.

Duration Cost
0-3 WEEKS $400
3 WEEKS - 3 MONTHS $450
3 MONTHS - 12 MONTHS $500
1 YEAR - 3 YEARS $600
3 YEARS - 7 YEARS $700
7 YEARS - 12 YEARS $800
12 YEARS - 16 YEARS $900
16 YEARS AND 30 YEARS $1000
Terms And Conditions
  1. Whilst Mr. Louay El Masri is a recognised circumciser, please note he is not a doctor or general practitioner.
  2. The procedure executed by Mr Masri is for the purpose of ritual and is not a medical procedure. Mr. Masri is a third generation Ritual Circumciser with over 15 years of experience and will perform to the standards expected of a Ritual Circumciser.
  3. Mr. Masri is a designated member of the community whose expertise in this eld will assist in your determination as to whether circumcision is the best decision for you, or your son.
  4. Mr. Masri’s circumcisions follows the traditional Islamic method for performing circumcisions on a person.
  5. Price may vary for the circumcision if the frenulum needs to be removed or any other skin conditions (these costs shall be disclosed prior to the procedure).
  6. Persons who act aggressively, whether through behaviour or tone, may result in a termination of circumcision services.
  7. As we are a Ritual Circumcision Centre we are not associated with Medicare or Private Health Insurance and our services cannot be claimed under those providers.
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