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From Dimensions at the Castro-Mission Health Center in San Francisco
reprinted with permission



DRAFT

Consent for Transgendered Patients Continuing Hormones

  1. I have informed my provider that I have been taking hormones for gender transition for ___________ (# of months or years).
  2. I agree to complete the full informed consent form within the next 30 days.
  3. I agree to complete all lab work, or other tests that my provider may order, within the next thirty days.
  4. I understand that, until I complete the labs and the informed consent, my provider will only write me a prescription for 30 days worth of hormones.

__________________________ _______________
Patient Signature Date

__________________________ _______________
Medical Provider Signature Date



Informed Consent to Continue Hormones
Informed Consent for Testosterone Therapy
Informed Consent for Estrogen Therapy
New Patient Flow Chart for Transgender Hormonal Treatment version 1?
New Patient Flow Chart for Transgender Hormonal Treatment version 2?
Flow Chart for New Patient Continuing Transgender Hormonal Treatment
Treatment Guidelines for MTF Transition
Treatment Guidelines for FTM Transition
FTM Handout
MTF Handout
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