Hormone and Surgery Readiness Assessment

Name (required)

Pronouns

Age (required)

Phone (required)

Email (required)

Do you have a supportive primary care provider?
(i.e., family doctor, nurse practitioner, or general practitioner)

UnsureYesNo

If needed, please contact TransCareBC to be connected with a primary care provider after completing this form.

Comments

I understand that Zoom is not a guaranteed confidential medium.

I confirm that I live in British Columbia, Canada.