TTBYOD Intake Questionniare

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*Choose your preferred pronouns.

*Choose your partners preferred pronouns

*Check off classes you plan to take or have taken.

*Check off any of the following that you have been diagnosed with.

*Check off any of the following mood disorders you have been diagnosed with now or in the past.

*Check off any of the following medical procedures you have had involving the uterus, cervix or vagina.

*Check off any of the following breast procedures or diagnosis that apply.

*Have your breasts changed during pregnancy?

Do you store guns outside of a locked safe in your home?

*Check off alternative practitioners you use or have used in the past.

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