providers for ICATHInformed Consent for Access to Trans Health Care

Dear Provider:

Thank you for working with me. As my provider you are in the position to offer me medical care that can support me to express my gender physically. I am writing this letter to request that you follow the standards of care outlined for this medication or procedure and allow us to use informed consent. I am aware of the following in regards to this gender affirming care and expect to discuss this with you in our appointment:

  • Potential social consequences
  • Potential occupational consequences
  • Potential effects on familial relationships
  • Potential financial costs
  • Potential impacts on mental and physical health

I am informed on the psychosocial impacts of this medical procedure and/or medication and am able to make an informed decision.


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