Forms, referrals & assessments

Forms, referrals & assessments

Access hormone therapy consent forms. Or follow the referral and assessment processes for gender-affirming surgeries.

Hormone therapy forms

These forms and additional clinical information on hormone therapy can be found in Trans Care BC's Primary Care Toolkit below.

Surgery forms

Detailed pathways for surgery assessment & referral

Below you'll find surgery assessment and referral processes by surgery type.

Upper Surgery

Breast construction A gender-affirming upper surgery (also called breast augmentation) that creates, enlarges or shapes one’s breasts by placing implants underneath natural breast tissue or muscle. is a surgical procedure that creates, enlarges, or shapes one's breasts.

Provincial benefit coverage

Gender-affirming breast construction surgery is covered by MSP The Medical Services Plan (MSP) is a B.C. government health plan that pays for physician services and referred services that are considered medically necessary, such as specialists (surgeon, psychiatrist, etc.), diagnostic x-rays, or laboratory services, for all BC residents. Some residents qualify for premium assistance for physiotherapy, chiropractic, naturopathy, massage therapy and acupuncture. .

Surgeons will recommend surgery for people who have breasts that have not developed in proportion to their body following an appropriate trial of hormone therapy (unless hormones are not clinically indicated). 

Surgery assessment and referral process

Step 1: Complete a surgical readiness assessment 

Surgical readiness assessments are required for gender-affirming MSP-funded breast construction surgery in BC. There are two options for completing the surgical readiness assessment.

A readiness assessment may not be required by surgeons offering this procedure through private pay. Call the surgeon's office directly to confirm their specific requirements.

Option 1: Referring provider completes the assessment.

The surgical readiness assessment for breast surgery can be provided by clinicians who meet the qualifications and competencies outlined in WPATH SOC 8. This includes non-medical mental health providers. A patient’s referring provider can complete this assessment if they meet the qualifications.

To complete a surgical readiness assessment, use the Surgical Readiness Assessment: Upper Surgery & Gonadectomy.

Option 2: Provider refers patient to assessor.

If the referring provider is not qualified or unable to complete an assessment for the patient, they can:

  • Refer the patient to a provider in community who can complete an assessment. Pathways may offer more information about referral pathways in your community.
  • Advise the patient to follow up with Trans Care BC’s health navigation team for information about private-pay and some limited free options for surgical readiness assessment through mental health providers in community.
  • Download and use the Referral for Upper Surgery to refer the patient to Trans Care BC. (Select the checkbox, "Please coordinate an appointment for surgical readiness assessment for this patient.")
Step 2: Refer the patient

Once an assessment is complete it must be included in the referral package for surgery. There are two options for referring the patient.

Option 1: The referral goes to a network of surgeons trained to provide gender-affirming surgeries, working from a centralized waitlist.
  1. Fax the following to Trans Care BC (604-297-9900):
  2. Trans Care BC manages a Central Waitlist and will add the patient to the list once they receive the package outlined above.
  3. Trans Care BC will contact the patient to discuss surgeons who the patient is eligible to see and associated surgeon wait times. The patient will provide Trans Care BC with their choice of surgeon.
  4. Trans Care BC will forward the referral package to the surgeon's office.
  5. The surgeon will assess the patient and complete the funding application if indicated.
Option 2: The referral goes to a plastic surgeon of the patient's choice (they are not affiliated with the network in Option 1).
  1. Contact the plastic surgeon directly to determine what documentation they require to accept a referral. You may use the use the RACEapp+, eCASE, or call the RACE line and select the Transgender Health option for information on surgeons who are experienced in gender-affirming care Processes through which a health care system cares for and supports an individual while recognizing and acknowledging their gender and expression. .
  2. The surgeon will assess the patient and complete the funding application if indicated.

Revisions

  • Patients can follow up directly with their original surgeon.
  • If the patient cannot follow up with their original surgeon you can refer them to the Trans Care BC Upper Surgery Central Waitlist for revision A follow-up procedure or adjustment to a previous surgical operation or treatment to correct or improve its outcome. . To do this, fax a new Referral for Upper Surgery and use the 'Revision' checkbox.
  • Alternatively, a referral for revision may be sent to a different plastic surgeon of the patient's choice. Contact the plastic surgeon directly to determine what documentation they require to accept a referral.  You may use the RACEapp+, eCASE, or call the RACE line and select the ‘Transgender Health’ option for information on surgeons who are experienced in gender-affirming care.
  • A new surgical recommendation is not required unless requested by the surgeon.

Chest construction A gender-affirming, upper surgery that removes breast tissue and sculpts remaining tissue into a shape that is typically considered to be more masculine. is a surgical procedure that removes or reduces breast tissue and skin to make a flatter chest.

Provincial benefit coverage

Gender-affirming chest construction is a benefit covered by MSP The Medical Services Plan (MSP) is a B.C. government health plan that pays for physician services and referred services that are considered medically necessary, such as specialists (surgeon, psychiatrist, etc.), diagnostic x-rays, or laboratory services, for all BC residents. Some residents qualify for premium assistance for physiotherapy, chiropractic, naturopathy, massage therapy and acupuncture. .

Surgery assessment and referral process

‎Step 1: Complete a surgical readiness assessment

Surgical readiness assessments are required for gender-affirming MSP-funded chest construction surgery in BC. There are two options for completing the surgical readiness assessment.

A readiness assessment may not be required by surgeons offering this procedure through private pay. Call the surgeon's office directly to confirm their specific requirements.

Option 1: Referring provider completes the assessment.

The surgical readiness assessments for chest construction surgery can be provided by clinicians who meet the qualifications and competencies outlined in WPATH SOC 8. This includes non-medical mental health providers. A patient’s referring provider can complete an assessment for them if they meet the qualifications.

To complete a surgical readiness assessment, use the Surgical Readiness Assessment: Upper Surgery & Gonadectomy.

Option 2: Provider refers patient to an assessor.

If the referring provider is not qualified or unable to complete an assessment for the patient, they can:

  • Refer the patient to a provider in community who can complete an assessment. Pathways may offer more information about referral pathways in your community.
  • Advise the patient to follow up with Trans Care BC’s health navigation team for information about private-pay and some limited free options for surgical readiness assessment through mental health providers in community.
  • Download and use the Referral for Upper Surgery to refer the patient to Trans Care BC. (Select the checkbox, "Please coordinate an appointment for surgical readiness assessment for this patient.")
Step 2: Refer the patient

Once an assessment is complete and received by the referring provider the patient can be referred.

Follow these instructions to make the referral.

  1. Fax the following to Trans Care BC: 604-297-9900:
  2. Trans Care BC manages the Central Waitlist, and will add the patient to the list once they receive the package outlined above.
  3. Trans Care BC will contact the patient to discuss surgeons who the patient is eligible to see and associated surgeon wait-times. The patient will provide Trans Care BC with their choice of surgeon.
  4. Trans Care BC will forward the referral package to the surgeon's office.
  5. The surgeon will see the patient for a consult.

Revisions

  • Patients can follow up directly with their original surgeon.
  • If the patient cannot follow up with their original surgeon they can be referred to the Trans Care BC Upper Surgery Central Waitlist for revision A follow-up procedure or adjustment to a previous surgical operation or treatment to correct or improve its outcome. . To do this, fax a new Referral for Upper Surgery and use the 'Revision' checkbox.
  • A new surgical recommendation is not required unless requested by the surgeon.  

 

Gonadectomy

Hysterectomy A gender-affirming lower surgery to remove all or part of the uterus and sometimes the ovaries and/or fallopian tubes. is a surgical procedure that removes the uterus. Salpingectomy A gender-affirming lower surgery to remove the fallopian tubes. is a surgical procedure that removes the fallopian tubes. Oophorectomy A gender-affirming lower surgery to remove the ovaries. is a surgical procedure that removes the ovaries.

These procedures can be done individually or in combination, depending on a person’s needs and goals. Some people choose to have just one, while others may have two or all three. Salpingectomy and oophorectomy can be done on one side (unilateral) or both sides (bilateral), depending on what is needed.

Provincial benefit coverage

This surgery is a benefit covered by MSP The Medical Services Plan (MSP) is a B.C. government health plan that pays for physician services and referred services that are considered medically necessary, such as specialists (surgeon, psychiatrist, etc.), diagnostic x-rays, or laboratory services, for all BC residents. Some residents qualify for premium assistance for physiotherapy, chiropractic, naturopathy, massage therapy and acupuncture. .

Surgery assessment and referral process

Step 1: Refer the patient to the obstetrician or gynecologist they choose.

You may use the RACEapp+, eCASE, or call the RACE line and select the Transgender Health option for information on surgeons experienced in providing gender-affirming care Processes through which a health care system cares for and supports an individual while recognizing and acknowledging their gender and expression. .

Step 2: Complete a surgical readiness assessment (if required).

Gonadectomy may not require surgical assessment. Please refer to the surgeon before submitting this form.

There are two options for completing the surgical readiness assessment if it is required.

Option 1: Referring provider completes the assessment.

If the obstetrician or gynecologist requests a surgical readiness assessment, one can be provided by clinicians who meet the qualifications and competencies outlined in WPATH SOC 8. This includes non-medical mental health providers. A patient’s referring provider can complete an assessment for them if they meet the qualifications.

To complete a surgical readiness assessment, use the Surgical Readiness Assessment: Upper Surgery & Gonadectomy.

Option 2: Provider refers patient to an assessor.

If the referring provider is not qualified or unable to complete an assessment for the patient, they can:

  • Refer the patient to a provider in community who can complete an assessment. Pathways may offer more information about referral pathways in your community.
  • Advise the patient to follow up with Trans Care BC’s health navigation team for information about private-pay and limited free options for surgical readiness assessment through mental health providers in community.
  • Download and use the Referral for Surgical Readiness Assessment to refer the patient to Trans Care BC.

Revisions

  • Patients can follow up directly with their original surgeon.
  • If the patient cannot follow up with their original surgeon they can be referred to a gynecologist or obstetrician of the patient's choice (see the section about the Hysterectomy referral process above).

Orchiectomy A gender-affirming lower surgery to remove the testicles. is a surgical procedure that removes the gonads (testes) and spermatic cord. Scrotectomy is a surgical procedure that removes all or part of the scrotum (the pouch of skin that typically holds the testicles).

Some people may choose to have a scrotectomy at the same time orchiectomy, or they may choose to retain the scrotal tissue. These decisions are based on each person’s needs and goals and are often made in collaboration with their surgeon.

Provincial benefit coverage

This surgery is a benefit covered by MSP The Medical Services Plan (MSP) is a B.C. government health plan that pays for physician services and referred services that are considered medically necessary, such as specialists (surgeon, psychiatrist, etc.), diagnostic x-rays, or laboratory services, for all BC residents. Some residents qualify for premium assistance for physiotherapy, chiropractic, naturopathy, massage therapy and acupuncture. .

Surgery assessment and referral process

There are two pathways for orchiectomy patients.

Option 1: Orchiectomy only
Step 1: Refer the patient to the urologist they choose.

You may use the RACEapp+, eCASE, or call the RACE line and select the Transgender Health option for information on surgeons who are experienced in gender-affirming care Processes through which a health care system cares for and supports an individual while recognizing and acknowledging their gender and expression. .

Gonadectomy may not require surgical assessment. Please refer to surgeon before submitting this form. 

Step 2: Complete a surgical readiness assessment (if required)

To complete a surgical readiness assessment, use the Surgical Readiness Assessment: Upper Surgery or Gonadectomy.

If the urologist requests a surgical readiness assessment, one can be provided by clinicians who meet the qualifications and competencies outlined in WPATH SOC 8. This includes non-medical mental health providers. A patient’s referring provider can complete an assessment for them if they meet the qualifications.

If the referring provider is not qualified or unable to complete an assessment for the patient, they can:

  • Refer the patient to a provider in community who can complete an assessment. Pathways may offer more information about referral pathways in your community.
  • Advise the patient to follow up with Trans Care BC’s health navigation team for information about private-pay options for surgical readiness assessment through mental health providers in community. There are some limited free options.
  • Download and use the Referral for Surgical Readiness Assessment to refer the patient to Trans Care BC.
Option 2: Orchiectomy done concurrently with vaginoplasty/vulvoplasty:

Orchiectomy can be done at the same time as vaginoplasty A gender-affirming genital surgery to create a vulva (including mons, labia, clitoris and urethral opening) and vagina. and vulvoplasty A gender-affirming genital surgery to create a vulva (including mons, labia, clitoris and urethral opening) and remove the penis, scrotum and testes. Vulvoplasty creates the external aspects of a vulva without creation of a vaginal canal. . In this case there is no need for a separate referral. See our section on Vaginoplasty & Vulvoplasty (below).

Revisions

  • Patients can follow up directly with their original surgeon.
  • If the patient cannot follow up with their original surgeon they can be referred to a urologist of the patient's choice (see Orchiectomy referral process Option 1 above)

 

Genital Surgery

Phalloplasty A gender-affirming lower surgery to create a penis and scrotal sac (phase 1) followed by testicular implants and implants to obtain rigidity/erection (phases 2 and 3). , metoidioplasty A gender-affirming lower surgery to create a penis. Metoidioplasty involves cutting ligaments around the clitoris to add length to the shaft and grafting skin around the shaft to create more girth. Optional additional procedures include scrotoplasty and urethral lengthening. and erectile tissue release This procedure creates a penis by cutting the ligaments around the erectile tissue (clitoris), so the shaft falls away from the body, giving it a more pronounced appearance. are three surgical procedures that create a penis An erogenous and erectile organ located between the legs that consists of spongy tissue that can fill up with blood and may become firmer with sexual arousal. It is also a means for urination. A person may be born with a penis or have one surgically created. When referring to genitals, the Trans Care BC website uses "erogenous tissue (penis)" for trans people assigned male at birth (AMAB) and "penis" for trans people assigned female at birth (AFAB), but there are many different terms that individuals may use. and scrotum (if desired).

Provincial benefit coverage

This surgery is a benefit covered by MSP The Medical Services Plan (MSP) is a B.C. government health plan that pays for physician services and referred services that are considered medically necessary, such as specialists (surgeon, psychiatrist, etc.), diagnostic x-rays, or laboratory services, for all BC residents. Some residents qualify for premium assistance for physiotherapy, chiropractic, naturopathy, massage therapy and acupuncture. .

Surgery assessment and referral process

Step 1: Conduct a surgical readiness assessment

To complete a surgical readiness assessment, use the Surgical Readiness Assessment: Genital Surgery.

Please note

Only individuals on Trans Care BC’s list of clinicians who are qualified to provide care planning Process that a person, their health care providers, family and other supporters undertake in planning to reach their gender-affirming care goals. for genital surgery may complete a readiness assessment for genital surgery. If you are interested in being added to this list, please email trans.edu@phsa.ca

The surgical readiness assessment for genital surgery is limited to medical providers who have the training outlined in the WPATH SOC 8 such as NPs, MDs, and RNs in a multidisciplinary care setting with MD or NP signoff. These providers must also have the ability to support care throughout the surgical journey (in conjunction with the surgeon and other relevant providers). 

If the referring provider is not qualified or unable to complete an assessment for the patient, they can:

Step 2: Refer the patient

Once an assessment is complete and received by the referring provider, you can refer the patient to Gender Surgery Program BC (GSPBC).

Follow these instructions to make the referral:

  1. Fax the following to the Gender Surgery Program BC (GSP BC) at 604-875-5075:
  2. GSP BC will add the patient to their waitlist.
  3. GSP BC will contact the patient to book a consult. Please contact the surgical program directly for updated information about wait-times for your patient’s specific procedure.

Revisions

Patients can follow up directly with their original surgeon or surgical program.

Vaginoplasty A gender-affirming genital surgery to create a vulva (including mons, labia, clitoris and urethral opening) and vagina. is a surgical procedure that creates a vulva and a vagina An internal organ located between the legs. A person may be born with a vagina or have one surgically created. When referring to genitals, the Trans Care BC website uses "internal genitals (vagina)" for trans people assigned female at birth (AFAB), and "vagina" or "vagina with vaginoplasty" for trans people assigned male at birth (AMAB), but there are many different terms that individuals may use. . Vulvoplasty A gender-affirming genital surgery to create a vulva (including mons, labia, clitoris and urethral opening) and remove the penis, scrotum and testes. Vulvoplasty creates the external aspects of a vulva without creation of a vaginal canal. is a surgical procedure that creates a vulva.

Provincial benefit coverage

This surgery is a benefit covered by MSP The Medical Services Plan (MSP) is a B.C. government health plan that pays for physician services and referred services that are considered medically necessary, such as specialists (surgeon, psychiatrist, etc.), diagnostic x-rays, or laboratory services, for all BC residents. Some residents qualify for premium assistance for physiotherapy, chiropractic, naturopathy, massage therapy and acupuncture. .

Surgery assessment and referral process

Step 1: Conduct a surgical readiness assessment 

To complete a surgical readiness assessment, use the Surgical Readiness Assessment: Genital Surgery.

Please note

Only individuals on Trans Care BC’s list of clinicians who are qualified to provide care planning Process that a person, their health care providers, family and other supporters undertake in planning to reach their gender-affirming care goals. for genital surgery may complete a readiness assessment for genital surgery. If you are interested in being added to this list, please email trans.edu@phsa.ca

The surgical readiness assessment for genital surgery is limited to medical providers who have the training outlined in the WPATH SOC 8, such as NPs, MDs, and RNs in a multidisciplinary care setting with MD or NP signoff. These providers must also have the ability to support care throughout the surgical journey (in conjunction with the surgeon and other relevant providers).

If the referring provider is not qualified or unable to complete an assessment for the patient, they can:

Step 2: Refer the patient

Once an assessment is complete and received by the referring provider the patient can be referred to Gender Surgery Program BC (GSPBC) or GRS Montreal.

Option 1: Gender Surgery Program B.C.

Follow these instructions to make the referral to GSPBC:

  1. Fax the following to the Gender Surgery Program BC (GSPBC) at 604-875-5075:
  2. GSPBC will add your patient to their waitlist.
  3. GSPBC will contact the patient to book a consult. Please contact the surgical program directly for updated information about wait-times for your patient’s specific procedure.
Option 2: GRS Montreal

Follow these instructions to make the referral to GRS Montreal:

  1. Fax the following to GRS Montreal at 1-514-288-3547:
    • A brief referral letter, including relevant clinical details not covered in the surgical readiness assessment form (such as BMI, medical history and recent consult reports).
    • Surgical Readiness Assessment: Genital Surgery
    • If it has been more than six months since the recommendation was completed, include an update on mental and physical health, readiness for surgery and any significant changes.
    • Required documents outlined in the GRS Montreal General Information guide.
  2. Once faxed, advise your patient to contact GRS Montreal by phone: 1-514-288-2097 or email info@grsmontreal.com to initiate their surgical booking.

Revisions

Patients can follow up directly with their original surgeon or surgical program. 

Support for clinicians

If you have any clinical questions or require assistance in supporting your patient post-operatively, contact the Trans Care BC health navigation team.

You may also use the RACEapp+, eCASE, or call the RACE line and select the ‘Transgender Health’ option to speak with a clinician experienced in providing gender-affirming pre- and post-operative care.

Need more information?

Contact our team of health navigators for information about referral pathways and resources for you and your patients.

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