The Queer Trans Project, Inc (EIN: 93-2233380) is a tax-exempt non-profit organization under Internal Revenue Code (IRC) section 501(c)(3). Donations and other contributions to The Queer Trans Project, Inc. are tax-deductible under IRC Section 170.
A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION OF THE QUEER TRANS PROJECT, INC, MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE (800-435-7352) WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE.
Gender Inclusive Medical Information
Your privacy and care matter. This document serves as a valuable resource for transgender individuals and allied healthcare providers, providing essential information to ensure affirming and competent care.
Download the FormHow to Use This Form
For Individuals:
- Download and print the form.
- Fill it out and take it to your healthcare provider.
- Any time is a good time to advocate for yourself, even if you're an established patient.
- This is just one part of the process. This should be a starting point into getting more inclusive and affirming care.
For Providers:
- Download and print the form for patients to fill out during their intake.
- Make it a standard part of the intake process.
- If you use virtual intake forms, download it, make it a fillable PDF, and incorporate it into your intake forms.
- Information provided by your clients should be used to create individualized care plans.
What's Included in the Form
- Personal Information (Preferred Name, Gender Identity, Pronouns)
- Anatomical Inventory
- Sexual Activity
- Routine Screening and Preventive Care
- Transition History
- Hormone Therapy Details
- Medical Transition Goals
This form collects essential information to assist healthcare providers in delivering personalized care that respects and affirms each individual's unique identity and needs. QTP does NOT retain any information.
Why This Form is Important
This form is crucial for advocating for yourself and ensuring you receive competent and respectful healthcare. It helps provide clear communication with your healthcare providers about your gender identity and medical history.
For healthcare providers, this form is a valuable tool for understanding and respecting the unique needs of transgender individuals, ensuring they receive personalized and affirming care.
Get Started Today
Download the Gender Inclusive Medical Information Sheet and share it with your healthcare provider to ensure you receive affirming and competent care.
Download Now