Request for health consultation for trans people

Trans People and Health Services Questionnaire

Completing the following form is your way to request services from Single Step’s team for health counselling, support related to your gender identity and/or medical transition. We understand that some of the questions may cause discomfort. Our many years of experience supporting trans and non-binary people has shown us that this form is the most gentle and effective option to gather the necessary information all at once and not delay the process later. After submitting your request, there will be a waiting period while we process it, after which you will be contacted by email. Single Step Foundation is a licensed provider of social services under the Social Services Quality Agency’s jurisdiction.

If you need emotional support, you can reach out on our anonymous online chat every night from 8-11 pm here on our website.

Name according to ID documents:*
First Name Surname
Chosen name:
Sex listed as on ID Documents:*
How do you currently define your gender identity:*
Preferred pronouns:
Year of birth:*
Place of birth:*
Current place of residence:*
Have you undergone any medical procedures for transitioning so far - hormones, surgeries, or others?*
If you have been on hormone replacement therapy, have you been under medical supervision?
Have you ever consulted a psychologist/psychotherapist?*
Have you ever consulted a psychiatrist?*
Have you ever used any of Single Step's services? If yes, please describe:*
Who referred you to us in the current instance?*
Email:*
Mobile phone:*
What support are you currently seeking from us? Please tell us more and describe your situation and your need for support related to gender identity and/or medical transition.*
GDPR*
I consent to my data being stored and processed. By completing this form, you consent to the storage and processing of your data by this website. More information can be found in the Privacy policy and the use of cookies