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Gender-Affirming Care Medical History Form
Medical History

Gender-Affirming Care Medical History Form

1 page•10 fields
Editable templateCustomize in minutes
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formisoft.com/f/transgender-care-medical-history
Gender-Affirming Care Medical History Form

Gender-Affirming Care Medical History Form

Page 1 of 1

Legal Name and Affirmed Name
Jane Martinez
Preferred Pronouns
Gender Identity
Select gender...
Sex Assigned at Birth
Female
Male
Intersex
Prefer not to answer
Current Gender-Affirming Medications
Previous Hormone Therapy History
Enter details here...
Gender-Affirming Surgeries Completed
Enter details here...
Transition Timeline and Goals
Enter details here...
Mental Health Support
Enter details here...
Reproductive Health Considerations
Enter details here...
Submit
Use this template

Sign up and start customizing in minutes.

Start with the Gender-Affirming Care Medical History Form template and tailor it to your practice. It includes 10 editable fields across 1 page. Included questions: Legal Name and Affirmed Name, Preferred Pronouns, Gender Identity, Sex Assigned at Birth. The full field list below shows what you will get when you add this template to your account.

Choose this template to open an editable form. Review the questions, keep only the information your practice needs, and add your branding. Preview the patient experience before sharing a link or embedding the form. Responses can be reviewed in Formisoft and exported as a PDF.

What's included

  • Legal Name and Affirmed Name
  • Preferred Pronouns
  • Gender Identity
  • Sex Assigned at Birth
  • Current Gender-Affirming Medications
  • Previous Hormone Therapy History
  • Gender-Affirming Surgeries Completed
  • Transition Timeline and Goals
  • Mental Health Support
  • Reproductive Health Considerations

Who uses this template

  • Gender-affirming hormone therapy clinics
  • Transgender surgical centers
  • Endocrinology practices with HRT programs
  • LGBTQ-focused primary care practices
  • Multidisciplinary gender identity clinics

All form fields

10 fields across 1 page. Customize any field after signing up.

Legal Name and Affirmed NameText
Preferred PronounsText
Gender IdentityDropdown
Sex Assigned at BirthMultiple Choice
Current Gender-Affirming MedicationsMedications
Previous Hormone Therapy HistoryLong Text
Gender-Affirming Surgeries CompletedLong Text
Transition Timeline and GoalsLong Text
Mental Health SupportLong Text
Reproductive Health ConsiderationsLong Text

How to use the Gender-Affirming Care Medical History Form

Getting started with this template takes just a few minutes. Sign up for a Formisoft trial, then select the Gender-Affirming Care Medical History Form from the template library. Review the included questions, customize your fields, and preview the form before sharing it.

Setup steps

  1. 1Choose the template. Find the Gender-Affirming Care Medical History Form in the template library and click “Use this template” to add it to your account.
  2. 2Customize fields. Add, remove, or reorder any of the 10 fields. Set fields as required or optional based on your practice needs.
  3. 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
  4. 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
  5. 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.

Frequently asked questions

How does Formisoft protect responses?

Formisoft provides secure form collection and a Business Associate Agreement (BAA). Your practice must review the form content, access permissions, and sharing workflow for its requirements.

Can I customize the fields in this template?

Absolutely. You can add, remove, reorder, or modify any of the 10 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

How do patients fill out this form?

Patients receive a link via SMS, email, or QR code. They complete the form on their phone, tablet, or computer before their appointment. No app download required.

Can I send this form automatically before appointments?

With a plan that includes automation, you can configure workflows to send forms and reminders. Appointment-based sending requires the booking event to reach Formisoft.

Does this template work on mobile devices?

Yes. The Gender-Affirming Care Medical History Form is fully responsive and works on any device. Most patients complete intake forms on their phone, so every template is optimized for mobile-first use.

Start with this template

Sign up and start customizing the Gender-Affirming Care Medical History Form for your practice. Set up in minutes.

Use this templateBrowse all templates

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