• Image field 49
  • Trans Wait Well Service - Referral Form

  • Eligibility

  • Your Age*
  • Only people aged 18 or older are eligible to access this service.

    If you aged under 18, you can still provide some information that we will use to evidence the demand for the service.

    If you would like to access any emotional support or explore your options, please contact one of our helplines:

    LGBT Foundation

    Phone - 0345 3 30 30 30 (Monday - Friday 9am - 6pm)

    Email -  helpline@lgbt.foundation 

    Gendered Intelligence

    Phone - 0800 640 8046 

    WhatsApp - 07592 650 496

    (Phone & WhatsApp - Monday 12-5pm; Tuesday 2-7pm; Wednesday 10-3pm; Thursday 12-5pm; Friday 10-3pm)

    Email - supportline@genderedintelligence.co.uk 

  • Which GIC are you registered with?*
  • This service is currently only commissioned to support patients on the wait list at The Laurels/Exeter Gender Identiy Clinic.

    If you are registered with another GIC that is not Laurels/Exeter GIC, you can still provide some information that we will use to evidence the demand for the service.

    If you would like to access any emotional support or explore your options, please contact one of our helplines:

    LGBT Foundation

    Phone - 0345 3 30 30 30 (Monday - Friday 9am - 6pm)

    Email -  helpline@lgbt.foundation  

    Gendered Intelligence

    Phone - 0800 640 8046 

    WhatsApp - 07592 650 496

    (Phone & WhatsApp - Monday 12-5pm; Tuesday 2-7pm; Wednesday 10-3pm; Thursday 12-5pm; Friday 10-3pm)

    Email - supportline@genderedintelligence.co.uk  

  • Your Details

  • What are your pronouns?

  • Format: 07000000000.
  •  -
  • Services Form

  • How long have you been on the GIC wait list (approximately)
  • For the following questions, please provide a number from 1 - 5 to say how much you agree of disagree with each of the statements

    1 = Strongly disagree
    2 = Disagree
    3 = Neutral
    4 = Agree
    5 = Strongly Agree

  • For a detailed list of each service and what it includes, visit the service web page

  • Which of the following services would you like to access? (select all that apply)*
  • Do you have access to any of the following in order to engage with our support options?
  • What do you hope to get support with during your time in the service? (select all that apply)
  • Wellbeing & Current Support

  • Are you currently receiving support from any other services?
  • Who would you to turn to for social support during your transition? (select all that apply)
  • Confidentiality & Email Permission

    We understand that confidentiality is important to our service users. The information that you share with us will be kept in the strictest confidence and in accordance with the Data Protection Act (2018). During our initial phone call, a member of the team will explain to the service user the exceptional circumstances when confidential information will have to be shared, for example, if they or somebody else is at risk of significant harm or where there is a requirement in law in the case of serious criminal offences (in particular terrorism and money laundering). In such exceptional circumstances, we will try to get their consent before disclosing any information if that is possible and do our best to help them. For further info on our policy please contact us at 0345 3 30 30 30.

    Confidentiality Agreement

    By completing this form and signing the declaration below, you understand and agree to the following;

    LGBT Foundation & Gendered Intelligence will collect information about you and the care you receive. This includes your referral form, assessments notes, paperwork related to the services that you access and correspondence related to your care. Your information will be stored in paper form and/or in electronic records. All data that is collected is subject to the strict rules of confidentiality laid down by Acts of Parliament, including the Data Protection Act 2018, the Health and Social Care Act 2001. LGBT Foundation & Gendered Intelligence may also get information about you from certain other organisations or give information about you to them; to make sure the information is accurate, prevent or detect crime or significant risk, and protect public funds. These organisations include local authorities, the police, and other healthcare professionals.

  • As part of the service, we will email you with service information, links to groups & sessions, and feedback forms about your experience.

  • Demographics

  • Which of the following best describes how you think of yourself?
  • Which of the following best describes how you think of yourself?
  • Which of the following ethnicities best describes how you think of yourself?
  • Do you consider yourself to be disabled and/or neurodivergent?
  • Should be Empty: