GAS Gender Affirming Surgery/Procedure Letter Request/Referral

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WHOLEHEARTED PSYCH | Dr. addyson tucker (they/them) - Licensed Psychologist in RI & MA

This form NOT for ongoing counseling, or sensitive info that requires an immediate or urgent response.

It is for 2STGNB adults *ONLY LOCATED in MA & RI* who are hoping to obtain a 'behavioral/mental health' referral for gender affirming surgery (GAS), medical procedure, or another letter (e.g., name change). This document will serve as a wait list when I am booking out more than 2 months, and I encourage you to consider other options in the meantime (read update below)

*READ* *UPDATE as of Apr 2024* Assessments are currently in progress, offering up to 1-2 spots per month typically. Currently booking in May/June 2024. [VALIDATION phrase: "it's raining them"]

For those located in RI, *Highly recommend* considering the Lifespan Gender Clinic and Hasbro (if 24 or under) for much quicker access to assessments, as their providers have reserved spots for this and can accommodate folks more quickly.
For those in RI & MA: You may search thegalap.org for other providers in your state who offer this service (there are quite a few Galap providers in MA), and if you are near another state/could be located there for the assessment with access to wifi, you might consider searching nearby states as well.

Trans & nonbinary adults, add your email to the interest list to be notified when the next 10-week Trans Self-Compassion group/workshop series is enrolling (likely late fall/early spring), at www.wholeheartedpsych.com/tsc-workshop.

Subscribe to newsletter with gender, racial, & body liberation resources: http://whpsych.2.vu/newsletter
I am a pledging member of GALAP, which you can learn more about at https://thegalap.org
Learn more about the GAS assessment/referral process here: http://whpsych.2.vu/GAS_info
Questions about my practice or this form? Email: addyson@wholeheartedpsych.com
Learn more about other offerings here: http://whpsych.2.vu/groups-workshops
Access this form again: [http://whpsych.2.vu/GAS_inquiry]

Email *

Please read ***UPDATE above re: my availability / wait list status, and write the 'validation phrase' as indicated: *

I'm addyson. What first name would you like me to use for you? *

What is your last name? *

I use they/them pronouns. What gender pronouns should I use for you?

Phone number where I can message and/or call you *

Are you 18 or older? If not, please indicate the date you will turn 18. *

Yes

Other:

I am only able to provide assessments to those who are located/reside in the states I am licensed (RI & MA). Please confirm your location. *

I reside in Massachusetts.

I reside in Rhode Island.

I do not reside in MA or RI but will be located in RI or MA for the telehealth appointment.

Other:

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