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Printable ftm top surgery letter 2026

The document is a letter of recommendation template for the FTM Top Surgery® Procedure, which is a chest surgery for individuals transitioning from female to male. It outlines the requirements for obtaining a recommendation from a physician or therapist, including necessary patient information and criteria that must be met to ensure the patient's readiness for surgery. The letter adheres to WPATH guidelines and emphasizes the importance of mental health professional involvement in assessing gender dysphoria and the patient's capacity for informed consent.

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Click ‘Get Form’ to open the printable FTM Top Surgery letter in the editor.
Begin by entering the Patient Legal Name, Date of Birth, Address, and Telephone Number in the designated fields. Ensure accuracy as this information is crucial for identification.
Proceed to Section A. Check the boxes confirming that chest surgery is the next step in the transition process and that the patient meets the age requirement of at least 18 years.
Move on to Section B. Here, you can check additional boxes that provide further documentation regarding the patient's mental health status and readiness for surgery. Attach separate letters if necessary for detailed explanations.
Finally, ensure that a Physician or Therapist signature is provided along with their name, office address, and telephone number at the bottom of the form.

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Can any therapist write a letter for top surgery?

A letter of support may be obtained after a one-time evaluation by a therapist, psychiatrist, or other mental health professional, who MUST have an official mental health license (ex. LPC, LCSW, Ph. D or a PsyD). If you do not have an established therapist, we can recommend someone who we work with.

What kind of letter do you need for top surgery?

To undergo this procedure, many individuals, including those seeking male-to-female top surgery and female-to-male top surgery, require a World Professional Association for Transgender Health (WPATH) letter.

Can you get top surgery without a letter?

Surgeons who operate under informed consent do not require a letter from a mental health professional. However, if youre using insurance youll still need to submit one or two support letters to the insurance provider.

Can any therapist write a top surgery letter?

It is not necessary to have an established therapist, because not every patient seeking top surgery has a need for ongoing therapy. A letter of support may be obtained after a one-time evaluation by a therapist, psychiatrist, or other mental health professional, who MUST have an official mental health license (ex.

Where can I get a letter for top surgery?

As a mental health professional, I recommend calling offices of therapists that seem allied and asking if they can provide a letter for top surgery. If the office says no, you have your answer.