Gender-Affirming Care Medical History Form
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Gender-Affirming Care Medical History Form
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This gender-affirming care medical history form provides a specialized, culturally competent tool for healthcare providers serving transgender and gender diverse patients. The form uses inclusive language and thoughtfully designed questions to gather comprehensive medical history relevant to gender transition care, including current and past hormone therapy, surgical interventions, mental health support, and baseline health screenings. Ideal for endocrinologists, primary care providers, plastic surgeons, and multidisciplinary gender clinics that provide hormone replacement therapy, surgical consultations, and ongoing transgender healthcare services.
The medical history workflow includes sections for affirmed name and pronouns, gender identity and expression, transition timeline and goals, current and previous hormone regimens with monitoring history, surgical procedures completed or planned, reproductive health considerations, mental health and support systems, and baseline cardiovascular and metabolic health screening. The form prioritizes patient dignity and confidentiality while capturing clinical information essential for safe, effective gender-affirming treatment. Perfect for specialized gender clinics, informed consent HRT programs, transgender surgical centers, and primary care practices committed to providing inclusive, evidence-based care for transgender and non-binary patients.
What's included
- Affirmed name and pronoun documentation
- Gender identity and expression history
- Current hormone therapy regimen and monitoring
- Previous transition-related treatments
- Surgical history and future surgical goals
- Reproductive health and fertility considerations
- Mental health and psychosocial support
- Cardiovascular and metabolic health screening
- Family history of relevant conditions
- Insurance and financial access 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 3 pages. Customize any field after signing up.
How to use the Gender-Affirming Care Medical History Form
Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the Gender-Affirming Care Medical History Form from the template library. The form is ready to use immediately, but you can customize every field, add your practice logo, and adjust the layout to match your workflow.
Setup steps
- 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.
- 2Customize fields. Add, remove, or reorder any of the 19 fields. Set fields as required or optional based on your practice needs.
- 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
- 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
- 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.
Frequently asked questions
Is the Gender-Affirming Care Medical History Form HIPAA compliant?
Yes. All Formisoft templates, including the Gender-Affirming Care Medical History Form, are HIPAA compliant. Data is encrypted with 256-bit AES at rest and TLS 1.3 in transit. A Business Associate Agreement (BAA) is included on every plan.
Can I customize the fields in this template?
Absolutely. You can add, remove, reorder, or modify any of the 19 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?
Yes. Formisoft's workflow automation can send intake forms automatically when an appointment is booked. You can set the timing (e.g., 48 hours before the visit) and include reminders for patients who haven't completed it.
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.
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