Do you have a General Practitioner ?
If so please add his/her name/address below.

Yes

No

Are you currently under the care of a Psychologist or Psychotherapist to help you through your transition ?

Yes

No

Are you living in the community as a woman ?

Yes

No

What type of employment are you in ?   
Are you recognised in your employment as a woman ?

Yes

No

Do you have support from your family and friends ?

Yes

No

Your Details

Your GP's Details

Name
Address
City
Country
Telephone

Include Country/Area code

Include Country/Area code

Facsimile

Include Country/Area code

Include Country/Area code

E-mail
 

 

 

                   

 

 

 

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