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Transgender Intake Form

The transgender intake form is used by medical and mental health professionals to gather information about a person's gender identity and transgender status. The form is used to help providers understand a person's unique needs and how to best support them. The form can also be used to track progress and changes over time.

Time to complete

3 minutes

Eligibility

You must be above 18 years of age to fill the Transgender Intake Form.

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Questions for Transgender Intake Form

1.

Full Name

The answer should be a text input.
2.

Age

The answer should be a single choice:
  1. Under 18
  2. 18-24 years old
  3. 25-34 years old
  4. 35-44 years old
  5. 45-54 years old
  6. Over 55
3.

Date of Birth

The answer should be a date input.
4.

Email Address

The answer should be an email input.
5.

Home Address

The answer should be a text input.
6.

Nationality

The answer should be a country.
7.

Gender

The answer should be a single choice:
  1. Male
  2. Female
  3. Transgender male to female
  4. Transgender female to male
  5. Non Binary
8.

Preferred pronouns

The answer should be a single choice:
  1. He/him/his
  2. She/her/hers
  3. They/them/theirs
  4. Ze/hir
9.

What is your educational background?

The answer should be a text input.
10.

What are your hobbies and interests?

The answer should be a text input.
11.

What are your health concerns?

The answer should be a text input.
12.

What is your current relationship status?

The answer should be a text input.
13.

Is there anything else you would like us to know?

The answer should be a text input.

Similar Ideas

  • LGBT Intake Form
  • Non-Binary Intake Form
  • Genderqueer Intake Form
  • Genderfluid Intake Form
  • Agender Intake Form
  • Bigender Intake Form
  • Transgender Ally Intake Form
  • Cisgender Intake Form

Here are some FAQs and additional information
on
Transgender Intake Form

What information is required on the transgender intake form?

The transgender intake form requires individuals to provide personal information such as their name, date of birth, and contact information. Additionally, the form asks individuals to describe their transgender status, which may include information about their gender identity, transgender history, and medical transition.

How is the transgender intake form used?

The transgender intake form is used to collect information about an individual's transgender status. This information is used to help determine eligibility for transgender-specific health care and other services. Additionally, the form may be used to help plan and coordinate transition-related care.

How often is the transgender intake form updated?

The transgender intake form is updated as needed.

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