Request A GRC Support Letter

The following details are required before issuing your Gender Recognition support letter:

(Please note you must be an existing patient to make a request)

Are You On The Monthly Payment Plan?

Yes No

Full Previous Name

Full Current Name

Date on Deed Poll

Date of Gender Dysphoria Diagnosis

Diagnosing Clinician

Surgery Status

If You Have Not Had Surgery Please State Why

Planned Surgery (If Any)

Current Hormone Medication (Including Dose)

Mobile Number

Email Address

Date of Birth

Home Address Line 1

City

Postcode

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The Gender Hormone Clinic

Providing affirmative, patient centred gender affirming hormone therapy led by our expert nursing team and multi disciplinary team of psychiatrists, psychologists and surgeons.

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