Medical Forms

This section contains forms to support clinicians  providing gender-affirming care, including surgical referrals, surgical readiness assessments, and patient consent forms.

Surgical readiness assessment referral

Hormone therapy

Surgical readiness assessment

The forms below are for the use of trained, qualified surgical readiness assessors only. The surgeons who receive these forms have a list of the qualified surgical readiness assessors. Please Contact Us if you are interested in receiving training for surgical readiness assessment for gender-affirming surgeries.

  • Form A – surgical readiness recommendation template (for assessors only) 
  • Form B – second surgical readiness recommendation template (for assessors only) 

Surgery referral

    SOURCE: Medical Forms ( )
    Page printed: . Unofficial document if printed. Please refer to SOURCE for latest information.

    Copyright © Provincial Health Services Authority. All Rights Reserved.

      Copyright © 2020 Provincial Health Services Authority