Client Intake Form
Legal Name
*
Prefix
First Name
Middle Name
Last Name
Suffix
Preferred Name
*
Prefix
First Name
Middle Name
Last Name
Suffix
Preferred Pronouns
*
Age
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name changes sometimes require a year of verifiable residency in the state you are applying for name change in.
*
less then 1 year residency
more then 1 year residency
Name changes require a state and sometimes national background check. Have you been convicted of a felony in the last 10 years, AND are you needing a name change through the courts in Minnesota?
*
yes
no
Name changes require a state and sometimes national background check. Have you ever been convicted of a felony, And are you needing a name change through the courts in North Dakota?
*
yes
no
Are you currently on a no fly list with the FAA?
*
yes
no
Are you behind on child support and have had your passport suspended?
*
yes
no
Are you currently under a no contact order in any jurisdiction in the us?
*
yes
no
Preferred Contact Methods
*
Email
Preferred Contact Methods
Facebook
Preferred Contact Methods
Phone
Preferred Contact Methods
Other
Family Ancestry (for researching possible renaturalization/repatriation)
Any overseas contacts / friends / family in desired relocation country
country
Which of the following documents do you have, correct information or not, as these will all be needed to process almost all paperwork and court orders?
certified copy of birth certificate
social security card
current state id or drivers lisc.
valid or expired us passport
Which of the Following Services are needed
*
Legal Name Change
Gender Marker Change on State ID
Update Passport
Update State ID
Verifiable Medical Diagnosis
Verifiable Mental Health Diagnosis
Country Selection Assessment
Securing Medications for extended period (2 years)
Shipping hormone prescription refills(where legal)
Property Shipping(this isn't formalized yet)
Due to Gender Care Guidelines in foreign countries, you may not have access to GAHT or surgical treatments for several years. Have you considered that this will probably delay your transition goals?
*
I have no further surgical goals
I have no surgical goals in the next 5 years
I have planned or scheduled surgeries in the next 1 to 2 years
I have planned or scheduled surgeries in the next 6 months to 1 year
Due to Gender Care Guidelines in foreign countries, you may not have access to GAHT or surgical treatments for several years. Have you considered that this will probably delay your transition goals?
*
I have no further use for hormonal treatments
I have no hormone medication goals in the next 5 years
I have stockpiled hormones for the next 1 to 2 years
I have stockpiled hormones for the next 6 months to 1 year
I need help acquiring enough hormones to last the lapse in care from moving
Current Hormone regimen
*
intramuscular injection
subcutaneous injection
oral
topical patches
topical gel
other
none
We expect anyone who is a client, to commit to help any future clients, successfully emigrate to their new home country. Are you willing to commit to helping future TRANSport clients inside your new home country?
*
ABSOLUTELY
NO
Please verify that you are human
*
Submit
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