Before our consultation it would be extremely helpful if you were able to prepare answers the following questions which are asked of every new patient.  Doing so will speed things up and allow us more time to talk about you as an individual! 

How old are you? ………

Are you employed?  Yes/NoIf so what do you do for a living ………..

How tall are you, (in cm preferably: Ft & ins if not)? ………

How heavy are you, (in Kg preferably: St & lbs if not)? ………

How long have you been living in your desired role? ……………… 

Which Gender Identity Clinic (GIC) has referred you? ………………….

Do you bind?Yes/ NoIf Yes, how long have you been doing so for? ………

Do you take testosterone Yes/NoIf so what form/name currently? ………

When did you start ………

Have you changed your forename?Yes/NoIf Yes, when? ………

How long have you suffered with gender dysphoria? ………

Do you have a good support network?Yes/No

Parents? Y/N/NA

Siblings (Brothers/Sisters) Y/N/NA

Work colleagues Y/N/NA

Friends. Y/N

What medication do you take; regularly/ once in a while? ………

Are you allergic to anything? ………

Do you smoke? If so how many a day?  ……….

If an ex-smoker, when did you give up? …..

VapeYes/No(Nicotine ? Y/N)

Do you drink alcohol?Yes/NoIf so roughly how much a week?.....

Is there any family history of Breast or Ovarian CancerYes/ No Details…..

Have you ever been pregnant?……

Have you had any medical illnesses in the past, if so, what and when?

Have you had any operations in the past, if so, what and when?

Have you had any psychiatric illness in the past? …………

Do you have any specific anxiety about the consultation that I should know about to help put you at ease?

Thank you

Robert Morris