Gender-Affirming Care Medical History Form
Asks about legal name and affirmed name, preferred pronouns, and gender identity. Built for gender-affirming hormone therapy clinics.
- Questions
- 10
- Page
- 1
- Time
- about 3 min
Includes
- Medication list
Your practice
Gender-Affirming Care Medical History Form
Live preview. Tap through it like a patient.
Who it is for
- Gender-affirming hormone therapy clinics
- Transgender surgical centers
- Endocrinology practices with HRT programs
- LGBTQ-focused primary care practices
- Multidisciplinary gender identity clinics
What's inside
- Legal Name and Affirmed NameText
- Preferred PronounsText
- Gender IdentityDropdown · 5 choices
- Sex Assigned at BirthMultiple Choice · 4 choices
- 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
From form to a ready patient

01
Make it yours
Reword, reorder, or add to the Gender-Affirming Care Medical History Form, and add your logo.

02
Patients finish it at home
A secure link by text or email, filled out on their phone before the visit. No app.

03
Your team sees who is ready
Each visit shows as ready once its forms are in. Answers land on the patient record.
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Questions
Send it before the visit, so patients arrive ready.
Add the Gender-Affirming Care Medical History Form to your account and make it yours in a few minutes.
Cancel anytime · BAA included