Preferred Name (First Name Only, :______________________________________
Date of Birth: ________/_______/____________
Today’s Date: _________/_________/________
?
What is your preferred Transgender Identification: (check one)
A. TRANSSEXUAL – A person interested in permanently changing gender through cross0gender hormones and various surgeries. This often includes cross living part time, with the end result being full time in a newly established gender identity prior to Genital Reassignment Surgery.
B. TRANSVESTITE/CROSSDRESSER – A person interested in wearing clothing of the opposite gender privately and/or socially as an opportunity to explore masculinity or femininity. Typically not interested in hormones, aesthetic surgeries, castration or genital assignment.
C. TRANSGENDERIST – A person in cross dressing and cross living part of full time. Typically not interested in Genital Reassignment Surgery. Possibly interested in hormones, aesthetic surgeries or castration.
D. ANDROGYNE – A person interested in taking on the characteristics of both or neither gender roles(s), i.e., male/female or occupying a middle ground. Not interested in Genital Reassignment Surgery. Possibly interested in hormones, aesthetic surgeries or castration.
E. INTERSEXED - A person that was born with both male and female Genitals.