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Denise O’Doherty

Denise O’Doherty

Licensed Professional Counselor, Licensed Marriage and Family Therapist, Drug and Alcohol Counselor, Registered Nurse

  • Relationship Counseling
    • Couples Therapy
    • Marriage Counseling & Family Therapy
    • Premarital Counseling
    • Domestic Abuse Counseling
    • IMAGO Relationship Therapy
    • LGBTQ Couples Therapy
  • Substance Abuse
    • Alcohol & Drug Addiction
    • SALCE Evaluations
  • Gender Identity / LGBTQ
    • A Guide For Parents of Transgender Children
    • Parents of Transgender Children
    • Gender Related Topics
      • Gender Dysphoria
      • Cross-Dressing
      • Adult Children of Transgender Parents
    • LGBTQ Related Topics
      • LGBTQ Issues
      • Corporate Sensitivity Training
  • Other Areas of Practice
    • Anxiety/Depression
    • BiPolar Disorder
    • Codependency/Personal Boundaries
    • Grief Counseling / Grief Therapy
    • Love Addiction/Love Avoidance
    • Overcoming Shame /Increasing Self-Esteem
    • Post Traumatic Stress Disorder
    • Dissociative Disorders
  • Blog

Letter for Gender Affirming Surgery and Consent

"*" indicates required fields

Legal Name:
Birth Name:*
Address*
MM slash DD slash YYYY
Have you had previous Psychotherapy?*
Have you had laser hair removal or electrolysis?*
Have you changed your name or gender?*
Do you take hormones?*
Endocrinologist, general practitioner, internal medicine physician, Gynecologist or other?
Have you had facial feminization?*
Include procedures and Surgeon's name and contact info.
Have you had voice coaching?*
Will you be maintaining your present job after you transition? (Initials)*
After surgery, I will be working*
After surgery, I will be a student:*
I can financially support myself:*
MM slash DD slash YYYY
Are your children aware of your plan to have surgery?*
Is sperm banking something that you would like to do prior to surgery as a reproductive option?*
I have a good network of friends who give me emotional support, accept me and support my transition.*
I am active in the transgender community.*
By signing this document below, I feel that I am psychologically and practically prepared to have Gender Affirmation Surgery, and, in addition, I am requesting a letter by Denise O'Doherty LPC MSN to be sent to my surgeon, confirming my informed consent. (Initials)
Reset signature Signature locked. Reset to sign again
This field is for validation purposes and should be left unchanged.
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