Transgender Hormone Therapy Intake Form
Asks about legal name, chosen name, and pronouns. Built for gender-affirming care clinics.
- Questions
- 9
- Page
- 1
- Time
- about 2 min
Includes
- Medication list
Your practice
Transgender Hormone Therapy Intake Form
Live preview. Tap through it like a patient.
Who it is for
- Gender-affirming care clinics
- Endocrinology practices
- LGBTQ health centers
- Primary care providers
- Transgender health specialists
What's inside
- Legal NameText
- Chosen NameText
- PronounsLong Text
- Date of BirthDate
- Gender IdentityDropdown · 5 choices
- Hormone Therapy GoalsLong Text
- Previous Gender-Affirming TreatmentsLong Text
- Mental Health SupportLong Text
- Current MedicationsMedications
From form to a ready patient

01
Make it yours
Reword, reorder, or add to the Transgender Hormone Therapy Intake 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.
Related templates
All templatesHormone Replacement Therapy Intake FormIntake · 14 questions
Endocrinology Intake FormIntake · 16 questions
Mental Health Intake FormIntake · 13 questions
Gender-Affirming Care Medical History FormMedical History · 10 questions
Clinical Trial Enrollment FormRegistration · 15 questions
Genetic Testing Consent FormConsent · 14 questions
Questions
Send it before the visit, so patients arrive ready.
Add the Transgender Hormone Therapy Intake Form to your account and make it yours in a few minutes.
Cancel anytime · BAA included