Medical Forms

This section contains forms related to gender-affirming hormone therapy and surgery.

Hormone therapy

These forms and additional information can be found in Trans Care BC's Primary Care Toolkit.

Surgical readiness assessment

The forms below are for the use of trained, qualified surgical readiness assessors only (the surgeons only accept forms completed by individuals on the list of trained providers). If you are interested in being trained as a surgical readiness assessor, please Contact Us.

  • Form A – surgical readiness recommendation template
  • Form B – second surgical readiness recommendation template

Surgery referral

Completed Surgical Readiness Assessments will be returned to the primary care provider who will then refer the patient as follows:

  1. Fax the following to Trans Care BC: 604-297-9900:
  1. Patient will be placed on the Central Waitlist (managed by Trans Care BC).
  2. Trans Care BC will contact patient to discuss their choice of surgeon.
  3. Trans Care BC will forward the referral package to the surgeon's office.
 

MSP-funded benefit only under special circumstances (less than AA cup breast development or > 1.5 cup size asymmetry after at least 18 months on hormone therapy)


Option 1:

Network of surgeons trained to provide gender-affirming surgeries, working from a centralized waitlist.


  1. Fax the following to Trans Care BC: 604-297-9900:
  2. Patient will be placed on the Central Waitlist (managed by Trans Care BC).
  3. Trans Care BC will contact patient to discuss their choice of surgeon.
  4. Trans Care BC will forward the referral package to the surgeon's office.
  5. Surgeon will assess the patient and complete the funding application if indicated.

Option 2:

Plastic surgeon of patient's choice (not affiliated with network).


  1. Contact plastic surgeon to determine what documentation they require to accept referral.
  2. Surgeon will assess the patient and complete the funding application if indicated.
  3. You may contact the RACE Line or e-CASE and select "Transgender Health" option for information on surgeons that are experienced in gender-affirming care.
  1. Refer to gynecologist of patient's choice.
  2. You may contact the RACE Line or e-CASE and select "Transgender Health" option for information on surgeons that are experienced in gender-affirming care.

Option 1:

Orchiectomy only:


  1. Refer to urologist of patient's choice.
  2. You may contact the RACE Line or e-CASE and select "Transgender Health" option for information on surgeons that are experienced in gender-affirming care.

Option 2:

Done concurrently with Vaginoplasty/Vulvoplasty:


  1. See “Vaginoplasty/Vulvoplasty” section.

Option 1:

Gender Surgery Program BC (GSP BC):


  1. Fax to the Gender Surgery Program BC (GSP BC): 604-875-5075
  1. GSP BC will add patient to their waitlist. 
  1. GSP BC will contact patient to book consult (this can take up to a year).

Option 2:

GRS Montreal:


  1. Fax to GRS Montreal: 1-514-288-3547

Once faxed, advise your patient to contact GRS Montreal by phone: 1-514-288-2097 or email: info@grsmontreal.com to initiate their surgical booking.

 

Option 1:

Gender Surgery Program BC (GSP BC):


  1. Fax the following to the Gender Surgery Program BC (GSPBC): 604-875-5075
  1. GSP BC will add your patient to their waitlist
  1. GSP BC will contact patient to book consult (this can take up to a year) 

Option 2:

GRS Montreal:


  1. Fax the following to GRS Montreal: 1-514-288-3547   
  1. Once faxed, advise your patient to contact GRS Montreal by phone: 1-514-288-2097 or email: info@grsmontreal.com to initiate their surgical booking.
 

If you require assistance in supporting your patient post-operatively, please contact the Trans Care BC Care Coordination team at: 1-866-999-1514. This team can also be accessed on an ongoing basis to support any clinical questions you may have. 

You may also contact the RACE Line or e-CASE and select "Transgender Health" option to speak with an clinician experienced in providing gender-affirming pre- and post- operative care.



SOURCE: Medical Forms ( )
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