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Gender Care Referral Form Instructions
PRINT & FAX: 5196421532, OR
PRINT & EMAIL: TRANSHEALTH@LIHC.ON.CAFAX: 5196421532
PHONE: 5196600874 ext. 1279
CLIENT MUST RESIDE IN LONDON, OND ate:CLIENT INFORMATION
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How to fill out gender care referral form
How to fill out gender care referral form
01
Obtain the gender care referral form from your healthcare provider or mental health professional.
02
Fill out your personal information such as name, date of birth, and contact information.
03
Specify the reason for seeking gender care treatment or therapy.
04
Provide any relevant medical history or information about previous treatments.
05
Have your healthcare provider or mental health professional sign and date the form before submitting it.
Who needs gender care referral form?
01
Individuals seeking gender-affirming healthcare treatment or therapy.
02
Those who require a referral to access specialized gender care services.
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What is gender care referral form?
Gender care referral form is a document used to request services related to gender healthcare.
Who is required to file gender care referral form?
Individuals seeking gender-affirming healthcare services are required to file a gender care referral form.
How to fill out gender care referral form?
To fill out a gender care referral form, individuals need to provide their personal information, healthcare history, and reason for seeking gender-affirming care.
What is the purpose of gender care referral form?
The purpose of gender care referral form is to facilitate access to gender-affirming healthcare services for individuals.
What information must be reported on gender care referral form?
Information such as personal details, medical history, insurance information, and reason for seeking gender-affirming care must be reported on a gender care referral form.
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