Forms

Please complete these 3 and bring to your first visit.

New Client Forms

New Client Intake Form

Office Policies & Procedures

Consent for Services

 

Evaluation Forms

SALCE Pre- Evaluation Sheets

 

Gender Therapy Forms

Letters for SRS:  M to F

Letters for Top Surgery & Consent:  F to M

Consent for Letter for Hormones

Letter Request

Gender History

Gender ASSET – (to be completed prior to surgery)

Family Comments – Child and Adolescent History

Gender Glossary

 

Additional Forms

Authorization for the Release of Confidential Information

Letter Request

Enneagram

Insurance Information Form

Family of Origin History

 

Contact me at 713-524-9525 or fill out the form below. I welcome your call so we can discuss your specific situation and the benefits therapy may provide for you.
 

Your Name (required)

Your Email (required)

Your Phone Number(required)

Additional Information You Would Like Me To Know About:

captcha
Please Enter The Characters Below: