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There are some basic changes you can make to your office's paperwork in order to have a more inclusive practice. Below are a few examples, and more examples can be seen in the documents at the bottom of this page:

 

Legal Name: __________________________

 

Preferred Name: ____________________________

 

Preferred Pronoun?    She      He    They
                                        Other: ______________

 

What gender is your birth gender?

  • Male

  • Female

  • Intersex

 

What is your current gender identity?

  • Female

  • Male

  • Transgender: Female to Male

  • Transgender: Male to Female

  • Other: ____________________________

 

Sexual Orientation Identity

  • Straight/Heterosexual

  • Gay

  • Lesbian

  • Queer

  • Bisexual

  • Asexual

  • Not sure/Don’t know

  • Other: ____________________________

 

Current Relationship Status

  • Single

  • Married

  • Domestic Partnership/Civil Union

  • Partnered

  • Separated from Spouse/Partner

  • Divorced/Permanently Separated from Spouse/Partner

  • Involved with multiple partners

  • Other: ____________________________

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