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PATIENTS INFORMATION Date:Social Security#:Patient Name: Last NameSuffixFirst NameMIPermanent Mailing Address: StreetCity/StateZip CodeStreetCity/StateZip CodePhysical Address: (If different than mailing)Home Phone: Sex:MCell Phone: FDOB: Femaleto Male/ Transgender MaleGender Identity: MaletoFemale/ Transgender Female NonBinary/ GenderqueerEmployer Name: OthersEmployer Phone:Employer Address: Street/Mailing FullTime
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How to fill out female-to male

01
Start by gathering all necessary documents required for the female-to-male process.
02
Research healthcare providers who specialize in gender transition.
03
Schedule an appointment with a healthcare professional for an initial consultation.
04
Discuss your transition goals and ask for recommendations on hormone therapy or surgeries.
05
Complete the required psychological evaluations, if needed.
06
Obtain a letter of support from a mental health professional outlining your gender dysphoria.
07
Follow the prescribed hormone therapy regimen as directed by your physician.
08
Maintain communication with your healthcare provider throughout your transition.

Who needs female-to male?

01
Individuals assigned female at birth who identify as male or wish to transition to a male gender identity.
02
People experiencing gender dysphoria and seeking to align their physical appearance with their gender identity.
03
Those who desire hormone therapy or surgical options to support their male transition.
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Female-to-male (FTM) refers to individuals who were assigned female at birth but identify and may transition to living as males.
Individuals who are transitioning from female to male, particularly in legal or medical contexts, may be required to file female-to-male documentation.
Filling out female-to-male typically involves providing personal information, current name, chosen name, and any relevant medical history to support the transition.
The purpose of female-to-male documentation is to formally acknowledge and facilitate the transition process for individuals identifying as male.
Information typically required includes the individual's legal name, chosen name, date of birth, medical history related to the transition, and any other relevant personal information.
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