Intake Form Guidance for Providers

Introduction & Instructions

This document provides suggested language for intake forms and paperwork to make them more inclusive for LGBTQ+ people. Reading through this document is likely to take 30 minutes or longer, and it is critical that you read the explanations in each section in order to provide competent and affirming care. You should plan to keep this document on file to serve as a reference.

The information in this document is important for all providers—not just those who specialize in care for LGBTQ+ people. LGBTQ+ people who experience discrimination, disparagement, or ignorance of basic aspects of their identity and life from healthcare providers often stop going to those providers, and those negative experiences may cause them to avoid all health care providers. A provider's intake forms and processes are typically the first place that people encounter that discrimination. Additionally, research shows that LGBTQ+ people are disproportionately impacted by health disparities due to various social determinants of health and stigma, including mental health issues like depression, anxiety, and suicidality, as well as physical health issues for certain subpopulations like HIV, smoking, cardiovascular disease, and some cancers. Given these health issues, it is essential that providers take steps to make their practices affirming. This will help LGBTQ+ people to engage in care and be retained in care. In light of the health disparities that exist, taking steps to make your practice affirming can potentially be life saving. 

In each section, there is an explanation of the reason for the field existing on paperwork, information about when this question may not be needed, and details on nuances to be mindful of. Supplemental resources are available in each section to aid in further learning on the topics. Each section has suggested wording for the respective questions. There also is a supplemental Glossary that may be useful if you are less familiar with the terminology used in this document.

Many of the sections below will benefit from a conversational approach rather than a written one as provided by an intake form. This helps ensure that the provider understands the nuance of these topics, and it could also be beneficial if the language is unfamiliar to the patient or simply because some people may be uncomfortable with the subject matter. Whenever possible, these questions should be asked during a private discussion with the patient, with the added practice of confirming that the patient is comfortable sharing information in front of any family and friends remaining in the room with them.

Throughout the document, we use the term “provider” to refer to any individuals or organizations providing healthcare or other services. We use the term “patient” to refer to anyone receiving such care or services. We recognize that this language may not resonate with all settings or contexts (e.g., “client” is used instead of “patient” in some fields). 

Providers should not expect to use all of the questions below in their intake forms and paperwork. Review the explanations for each question to determine whether the information is necessary to provide appropriate care for your patients, and only add those that are determined to be needed. Our expectation is that providers will review the explanations provided in this document and that they will also ask other office staff who will use the forms or interact with patients to read it as well. Part of providing competent and affirming care is engaging in affirming practices, and without the information in the explanation sections, the provider may be missing key details in their understanding of the issues involved, appropriately using and discussing the answers, the utility of the questions, and the appropriate times to ask or include them. Some questions will not be needed for all providers or contexts and could be viewed as invasive when this is the case, which may push clients away from your services or be marginalizing.

If you have questions or suggestions related to this document, please contact queeringmedicinelansing@gmail.com

General Resources on Health Disparities: 

• • CDC Health Disparities Among LGBTQ Youth
    https://www.cdc.gov/healthyyouth/disparities/health-disparities-among-lgbtq-youth.htm 

  • National LGBT Health Education Center: Understanding the Health Needs of LGBT People
    https://www.lgbtqiahealtheducation.org/wp-content/uploads/LGBTHealthDisparitiesMar2016.pdf 

Basic Demographics

Name You Go By

Although everyone has a name, not everyone's name is what's found on their ID or in legal databases. For example, many trans and nonbinary people use a name that is not the one they were given when they were born, but haven't legally changed it. People should always be addressed by the name that they go by, regardless of whether or not it is their legal name. Note that in some situations, which may include billing and coordinating care or referrals with other providers, using a person’s legal name may be unavoidable. If a patient provides a name they go by that differs from their legal name, communicate clearly with them about situations in which their legal name will be used, and always use the name they go by when speaking with them.

To ensure that the person filling out the form understands what you are asking for, don't just write "Name" (which is sometimes used to refer to the name someone goes by and sometimes used to refer to legal name); instead, use "name you go by" when asking for the name someone goes by.

There are a variety of barriers trans people face in pursuing a legal name change (the process is expensive, complicated, time consuming, and may create significant risks for people, depending on factors in their personal or professional life). Many trans people do legally change their name and many do not, and neither approach is better or worse than the other. Patients are coming to you for specific care or services, and whether or not the name they use in daily life is what's on their Driver's License or other ID isn't something you should seek to interfere with or judge them based on. Even people who aren't trans or nonbinary may not use their legal name in daily life. For example, someone whose legal name is "James Vincent Smith" may go by "Vince Smith."

Never use the term "Preferred Name"—that terminology is considered offensive and pejorative by most trans and nonbinary people. Whether or not someone has legally changed their name, the name you should use to address them isn't a simple matter of preference that you have the option to ignore; the name they go by is their name, and should not be denigrated by any qualifiers that imply that others can freely choose whether to use it or not.

Have a conversation with the patient to find out what name should be used during the check-in process and during their appointment. This is particularly critical if you or your staff will be calling out clients’ names while they are in the waiting room, if others may be able to see the name they write down on a sign-in sheet, or if a family member or friend accompanies them during their appointment. For many trans and nonbinary people, having family members, coworkers, or others find out the name they go by may cause them to lose their home, their job, or may cause other problems for them. For example, trans people have a significantly higher rate of homelessness than cisgender people, in part due to being thrown out by unsupportive family who they come out to or who otherwise find out that they are trans.

The name a person goes by can change over time, so you will need to integrate a process for checking for updates and updating records as needed.

Supplemental Resources:

• • National Center for Transgender Equality: Identity Documents & Privacy:
    https://transequality.org/issues/identity-documents-privacy 

  • "For trans Americans, changing your name can still be a matter of life or death":
    https://qz.com/651310/for-trans-americans-changing-your-name-can-still-be-a-matter-of-life-or-death/ 

  • Using Chosen Names Reduces Odds of Depression and Suicide in Transgender Youths
    https://news.utexas.edu/2018/03/30/name-use-matters-for-transgender-youths-mental-health/ 

Legal Name

It is often necessary for providers to know a person’s legal name, and it is generally required to bill their health insurance company or to coordinate insurance coverage. This may or may not be the same as the name they go by, and it should never be assumed that it is. When it is needed, a separate field must be added to gather the information.

Do not ask for someone's legal name unless you have a specific need for that information (e.g., billing or coordinating care or referrals with other providers). A person's legal name may not match the name they go by, and could reveal information about them that they do not wish to share (particularly if they are trans or nonbinary, and their legal name is stereotypically associated with the gender that was assigned to them at birth, but is not their actual gender). 

When asking for legal name, always refer to it as "Legal Name" and always put it after Name You Go By. Never refer to it as someone's "real name" (that implies that the name they go by is not real, which is incorrect, insulting, and inappropriate). Adding clarifying language like "(for example, name on driver’s license or state ID)" can help people who are not familiar with the term "legal name," and to make it easier for people whose name they go by and legal name are the same, add the qualifier "if different" to the the Legal Name question if it immediately follows the Name You Go By question, so that they can skip it.

If a patient provides a name they go by that differs from their legal name, but you anticipate that bills, mail, or other communications may be addressed to their legal name, let them know in advance. If you know that your medical printouts or internal systems default to a person’s legal name, you need to develop a workaround that will ensure that the name they go by will be used instead of their legal name at the appropriate times. Have a conversation with the client to find out what name they want you to use in the context of their appointment, and ask which name should be used at the point of check-in (where others may see or hear it).

A person’s legal name can change over time, so you will need to integrate a process for checking for updates and updating records as needed. If a patient is in the process of legally changing their name, there may be a delay before their health insurance information is updated, which can cause temporary problems with insurance billing.

Provide a disclaimer in the question that explains why being asked; such as “asked for insurance purposes,” to be transparent about the reason asked. 

Supplemental Resources:

• • National Center for Transgender Equality: Identity Documents & Privacy:
    https://transequality.org/issues/identity-documents-privacy 

  • "For trans Americans, changing your name can still be a matter of life or death":
    https://qz.com/651310/for-trans-americans-changing-your-name-can-still-be-a-matter-of-life-or-death/ 

  • Using Chosen Names Reduces Odds of Depression and Suicide in Transgender Youths:
    https://news.utexas.edu/2018/03/30/name-use-matters-for-transgender-youths-mental-health/ 

Gender

Asking about gender identity and not solely someone’s sex assigned at birth is important to providing affirming care in many situations, but if you do not need this information, you should not ask. If asking about gender, the checklist provided allows patients to check multiple responses in order to allow flexibility in how they report their gender in the most affirming way possible. For instance, not all transgender men and women identify with the term “transgender” and may instead just identify as men or women, respectively, and some people may identify as more than one gender or may use multiple terms to describe their gender. In this checklist format, patients are not required to disclose information that they do not wish to in regards to their gender history. 

This checklist includes gender identity options that are commonly used by cisgender, transgender, and gender diverse individuals, although this list is not exhaustive. You may choose to expand this list in your practice, but we would suggest not shortening it because this would result in not having key identity terms we believe are essential to include. Do not expand the list without consulting with appropriate experts, as some terms may be considered derogatory or offensive, and undermine efforts to be inclusive. The terms commonly used by trans and nonbinary people are evolving and change over time; check back regularly (e.g., annually) to ensure that you are using the most current list (some terms that were standard only a few years ago are now considered to be slurs). You should consult the Glossary at the end of this document to ensure that you understand the terms. 

If possible, you can simply ask about gender as an open-ended question that allows the patient to self-label their gender identity. If you have pre-formed options in your EHR/EMR or are collecting data in a more systematic way, then using the checklist provided may be more appropriate. 

A person’s gender identity can change over time, so you will need to integrate a process for checking for updates and updating records as needed.

Supplemental Resources:

• • Refinery 29’s Gender Nation Glossary:
    https://www.refinery29.com/en-us/lgbtq-definitions-gender-sexuality-terms 

  • National LGBT Health Education Center: Focus on Forms and Policy:
    https://www.lgbtqiahealtheducation.org/wp-content/uploads/2017/08/Forms-and-Policy-Brief.pdf 

  • Perspectives from Transgender and Gender Diverse People on How to Ask About Gender:
    https://www.researchgate.net/publication/342545119_Perspectives_from_Transgender_and_Gender_Diverse_People_on_How_to_Ask_About_Gender 

Sex Assigned at Birth

Sex assigned at birth is the designation that someone is given when they are born, most typically “male” or “female,” although some states are beginning to recognize intersex individuals on birth certificates. This designation is made usually based solely on external genitalia. The term “sex assigned at birth” and others “assigned male at birth” or “assigned female at birth” are more affirming than terms like “natal sex” or “sex.”

When providers assume a person’s sex assigned at birth based on appearance or gender, they are not providing adequate care. These assumptions lead to the invalidation of many trans and nonbinary people’s experiences, which can result in a patient not returning to a healthcare provider or avoiding healthcare providers overall, and can also lead to oversights in what types of care are relevant to a given patient. Whenever possible, these questions should be asked during a private discussion with the patient and not directly on an intake form.

It will not always be necessary for the provider to know an individual’s sex assigned at birth. For instance, a mental health provider may need this information to provide care and, in particular, if providing a letter of support for gender affirming medical care. Many other types of providers, like optometrists or dentists, are unlikely to need this information, unless it is needed for insurance or billing purposes or to coordinate care or referrals with other providers. However, when it is necessary to know, it’s important to recognize that an individual’s sex assigned at birth will not always align with their gender identity, gender presentation, or assumed anatomy or hormone levels. If knowing a patient’s anatomy is necessary to provide care (for example, if screening for cervical or testicular cancer), then providers would also need to have a conversation with the patient about their anatomy. It may also be different from what is recorded on an individual’s legal documents and what is on file with their insurance company. Thus, it is important not to conflate these concepts. 

Additionally, it is important to recognize and understand the existence of intersex individuals when asking such questions, as they are often left out, and most states use birth certificates on which there is no way to indicate that a person is intersex.

Supplemental Resources:

• • Planned Parenthood - What’s Intersex?
    https://www.plannedparenthood.org/learn/gender-identity/sex-gender-identity/whats-intersex

  • Intersex Society of North America - What is intersex?
    https://isna.org/faq/what_is_intersex/ 

Legal Sex/Gender

If you will be billing an insurance company or coordinating insurance coverage and need the patient's sex or gender for that purpose, it's necessary to ask for the sex or gender that the insurance company has on file for them, which will generally match the sex or gender on their state ID (sometimes referred to as “legal gender” or “legal sex”). Some insurance companies use a patient’s sex or gender as a means of identification (in concert with name and date of birth) or in their fraud detection systems, and the sex or gender the insurance company has on record may or may not match the person’s actual gender.

Do not ask for a person’s legal sex or gender unless you have a specific need for it, for example, if you are working with their insurance company or coordinating benefits with their insurance company (or with another provider who is working with their insurance company) and the insurance company requires that you provide that information. For many trans and nonbinary people, their legal sex or gender is what they were assigned at birth, not their actual gender. Disclosing that information can be traumatic for them, and it should therefore only be asked for when absolutely necessary.

Insurance companies typically use the legal sex or gender of a person, and do not allow them to update their records without going through legal processes first. If insurance is being provided via a person’s employer, the employer provides the information to the insurance company. Many trans and nonbinary people have not updated the gender on record with the state from what was initially assigned on their birth certificate, and their actual gender (as reported on your forms when asked in their demographics) may therefore not match what the insurance company has on record. For nonbinary people in Michigan and many other states, there is no way to properly update legal records to reflect their gender (in Michigan, “Male” and “Female” are the only options on Driver’s Licenses, state IDs, and in other state legal systems), and insurance records are therefore typically inaccurate.

A person’s legal sex or gender can change over time, so you will need to integrate a process for checking for updates and updating records as needed.

Supplemental Resources:

• National Center for Transgender Equality: Identity Documents & Privacy:
  https://transequality.org/issues/identity-documents-privacy 

Pronouns

Pronouns are the terms that people use to refer to themselves or others. Most people are familiar with pronouns like “she” or “he,” but there are many other pronouns that people use, for example gender-neutral pronouns like “they” instead of gendered terminology (e.g., “They are a patient of Dr. Smith”). 

It is important that providers do not assume what pronouns others use or make assumptions based on pronouns (e.g., not assuming someone’s pronouns based on their gender identity or appearance; not assuming a person’s gender identity based on the pronouns they use). The pronouns a person uses are not necessarily obvious and you do not know unless a patient has provided this information through some means, such as having a question about pronouns on your paperwork. When the person has not provided information on their pronouns to a provider, the provider should use they/them pronouns, which are gender-neutral, and not other terms that may be marginalizing (e.g., “it” or other potentially pejorative terms). Some people may just use their name and not specific pronouns, some may use pronouns that are less common (e.g., ze/hir, fae/faer) and others may use multiple pronouns (i.e., they may give you a choice between more than one set that they use - such as someone who uses both she/her or they/them pronouns). As such, this form item must provide a means for patients to check all that apply to them in the question as well as a “not listed” option. 

When providers do not ask for pronouns, they (and office staff) are at risk for using the wrong pronouns for their patients. Misgendering includes when individuals are referred to with the wrong pronouns or gender. Research shows that misgendering frequently happens for transgender individuals, is a barrier to engaging in healthcare (Puckett et al., 2018), and is associated with psychological distress and suicidality (McLemore, 2015, 2018; Russell et al., 2018). As such, asking about and using correct pronouns is a means for ensuring better health outcomes for your patient. 

It also is critical that after asking about pronouns, that these are the only pronouns used for patients. Having a space in your EHR/EMR where this information can be saved helps to ensure that it is readily available. Office staff should also be trained on using the pronouns on record for a patient.

Most providers and office staff will make mistakes at some point in time with their patients regarding their pronouns, gendered language, or even names—sometimes due to oversight, system limitations in EHRs/EMRs, not asking for this information, or other reasons. When you make a mistake, it is important to correct your mistake, make a brief apology, and then move on (e.g., “...then she said...I’m sorry, then they said…”). When people spend a lot of time apologizing or defending themselves with statements such as “I really am an ally to trans people,” this centers their experience and places patients in the inappropriate position of needing to soothe the provider’s discomfort. Additionally, the more time spent on apologizing and correcting a mistake, the more attention is focused on it and the harder it can be to continue a conversation. Instead, correct yourself, briefly apologize, move on, AND do better next time. Hold yourself accountable for not making this mistake in the future. 

Never use the term "Preferred Pronouns"—terminology is outdated, and is considered offensive and pejorative by most trans and nonbinary people. A person’s pronouns aren’t a simple matter of preference that you have the option to ignore; their pronouns are their pronouns, and should not be denigrated by any qualifiers that imply that others can freely choose whether to use them or not.

Pronouns can also change over time, so you will need to integrate a process for checking for updates and updating records as needed. 

Supplemental Resources:

• • MyPronouns.Org - Resources on Personal Pronouns:
    https://www.mypronouns.org 

  • A Game to Practice Using a Variety of Pronouns:
    https://pronouns.minus18.org.au/ 

  • Puckett, J. A., Cleary, P., Rossman, K., Mustanski, B., & Newcomb, M. E. (2018). Barriers to gender-affirming care for transgender and gender nonconforming individuals. Sexuality Research & Social Policy, 15(1), 48-59. doi:http://dx.doi.org.proxy1.cl.msu.edu/10.1007/s13178-017-0295-8

  • McLemore, K. A. (2018). A minority stress perspective on transgender individuals’ experiences with misgendering. Stigma and Health, 3(1), 53-64. doi:http://dx.doi.org.proxy1.cl.msu.edu/10.1037/sah0000070

  • McLemore, K. A. (2015). Experiences with misgendering: Identity misclassification of transgender spectrum individuals. Self and Identity, 14, 51-74. https://doi.org/10.1080/15298868.2014.950691

  • Russell, S. T., Pollitt, A. M., Li, G., Grossman, A. H. (2018). Chosen name use is linked to reduced depressive symptoms, suicidal ideation, and suicidal behavior among transgender youth. Journal of Adolescent Health, 63, 503-505. doi: 10.1016/j.jadohealth.2018.02.003

Honorifics

Honorifics refer to the titles that may be used to address others, such as “Mr.” and “Mrs.” In healthcare settings, it is often the case that patients may be referred to using an honorific and their last name—whether that be in the waiting room or when called over the phone. Most honorifics are gendered, but there are some , like “Dr.,” that are not. Another honorific that may be less familiar to providers is Mx., which is the most common gender-neutral honorific. Given that these terms are often used within offices, you should ask this information rather than assuming which honorific a person uses based on their appearance, gender identity, or other information. When you assume, you risk getting this information wrong and marginalizing patients, as well as potentially placing them in harm’s way if they choose to correct you in front of others in the waiting room. Patients should feel respected throughout the entire encounter with providers and directly asking for this information ensures a greater likelihood of a positive visit. 

A person’s honorifics can change over time, so you will need to integrate a process for checking for updates and updating records as needed. 

Supplemental Resources:

• Merriam-Webster Dictionary on the Gender Neutral Honorific Mx.:
  https://www.merriam-webster.com/words-at-play/mx-gender-neutral-title 

• Nonbinary Wikipedia:
  https://nonbinary.wiki/wiki/Mx 

Sexuality

Sexuality can be important to know in some medical contexts. The specific information (and therefore the appropriate question) that is needed will depend on the provider and the type of care. Questions are provided here related to sexual identity (the specific terms that individuals use to describe their sexual orientation), sexual activity status, and gender of sexual partners. See the relevant sections below for more information about each. Decisions should be made as to which questions are relevant and useful for a specific provider and context. Whenever possible, these questions should be asked during a private discussion with the patient and not directly on an intake form.

If this information is not needed, do not include it on your forms or in your intake processes. Be sure that you are not making assumptions about other questions based on responses to any given question. For instance, do not make assumptions that individuals of a particular sexual identity, such as gay, have partners of a specific gender; there are many factors that influence a person’s behavior. If you need to know the gender of sexual partners, that specific question must be asked, rather than relying on assumptions. Assumptions should not be made based on a person’s sexual or gender identity, occupation (e.g., sex work), relationship status, or living situation.

Sexual and Romantic Identities

Asking patients about their sexual identity—or who they are sexually attracted to—is not always relevant, nor are the lines between each clearly demarcated. Also, as noted in the explanations for other questions in this section, sexual identity does not necessarily indicate either sexual activity nor the type of sexual partners one has, nor the frequency of encounters. Information about patients' sexual identities should always be contextualized with other available and relevant data and for the patients’ reason for their visit. For instance, a gay cisgender man might be romantically involved with another cisgender man, but might identity as asexual, meaning sexual activity might not be relevant to their care (but not always). For these reasons, it’s always best to ask patients if contextually appropriate and they are comfortable.

It is also important to understand that sexual and romantic attraction are distinct concepts, and should be asked about separately if both are needed (the same answer options can be used for Romantic Identity, but with “-romantic” substituted for “-sexual,” for example “Aromantic” and “Biromantic” instead of “Asexual” and “Bisexual”).

It is worth noting that the term “homosexual” is viewed as outdated in many circles and is sometimes viewed as pejorative. Even so, some people still use this term to refer to themselves. Do not refer to patients using this term unless they specifically indicate that this is the term that they use, and try to avoid this language in making more general references to people who are not heterosexual. 

A person’s sexual identity can change over time, so you will need to integrate a process for checking for updates and updating records as needed.

Supplemental Resources:

• National LGBT Health Education Center: Focus on Forms and Policy:
  https://www.lgbtqiahealtheducation.org/wp-content/uploads/2017/08/Forms-and-Policy-Brief.pdf 

Sexually Active

To provide appropriate healthcare screenings, such as STI testing, it is important that providers know if a patient is sexually active. To know the genders of partners that a patient has sex with, refer to the question about sexual partners and discuss this with patients rather than making assumptions based on identity labels or the patient’s gender. Ideally, this question should only be offered in the context where the patients’ sexual health is directly related to their reason for visiting. 

Rather than including additional items on a written form, we suggest that a provider instead have a conversation with their patient to collect the information and learn more about their response to this question. Examples of follow up questions that could be asked (depending on relevancy to care): 

• • Recency of last sexual contact 

  • Use of protection and questions about needs for HIV/STI testing

There can also be incorrect assumptions about who can be pregnant based on gender or sexual identity. For example, women are not the only people who can get pregnant and not all women can get pregnant, and men are not the only people who produce sperm. Having this on a form enables people to be more comfortable providing this information, and reduces the likelihood of a provider’s assumptions causing it to be overlooked. 

To provide competent and affirming services, providers should directly ask about the genders and other sexual characteristics of the patient’s sexual partners, if that information is needed (see Sexual Partners question section). Providers can have a discussion with patients about the need for medical services that align with the types of sex they are engaging in. Providers should then have a conversation with their patients about the types of sex (e.g., receptive anal sex) that may relate to their care. Just knowing the gender identity of partners does not tell you the types of sex they are having. 

A person’s status as to whether they are currently sexually active can change over time, so you will need to integrate a process for checking for updates and updating records as needed.

Supplemental Resources: 

• National LGBT Health Education Center - Taking An Affirming Sexual History:
  https://fenwayhealth.org/wp-content/uploads/10.-Taking-an-Affirming-Sexual-History-Ard.pdf 

Sexual Partners

A person’s sexual identity (e.g., gay, straight, bisexual, asexual) does not provide information about who a person has sex with, although providers may find themselves making assumptions about this. In order to provide competent and affirming services, providers should directly ask about the genders of the patient’s sexual partners, if that information is needed. The answer choices for this question use the same terms as those used for the patient’s gender identity. If asked, providers should have a conversation with their patients about the types of sex (e.g., receptive anal sex) that may relate to their care. Just knowing the gender identity of partners does not tell you the types of sex they are having. 

Asking about sexual partners is relevant in some settings and not others. Providers should evaluate whether this information is relevant to their specific care with a patient. For instance, a provider who offers genitourinary or reproductive health care may need this information to be able to provide competent and affirming sexual health services whereas an optometrist or dentist does not need this information and should not ask for it. Conversations about sexual partners and sexual activity should be limited to the factual information necessary for providing care, not to offer opinions or judgements about patients. 

A person’s sexual partners can change over time, so you will need to integrate a process for checking for updates and updating records as needed.

Supplemental Resources:

• National LGBT Health Education Center - Taking An Affirming Sexual History:
  https://fenwayhealth.org/wp-content/uploads/10.-Taking-an-Affirming-Sexual-History-Ard.pdf 

Relationships

Relationship Status

These questions provide information about the relationship status and relationship structure of patients, and should only be asked if relevant to their care. Some providers might ask these questions to open a dialog on social support. Mental health providers in particular might ask these questions to gain a broader understanding of an individual’s personal life. Whenever possible, these questions should be asked during a private discussion with the patient and not directly on an intake form.

In asking about relationship status, it is important to allow the patient to select multiple answers to better reflect a more expansive view of relationships and the many ways they can be structured. Be sure not to make assumptions about the gender(s) of the patient’s partner(s). Do not assume the patient currently lives with their partner(s) or that the partner(s) are able to care for or provide transportation for the patient unless explicitly noted. Do not use their responses to pass judgment or as a way to admonish or belittle their relationship situation, or push your personal views on relationships (e.g., if an individual is polyamorous, do not criticize them or make statements that suggest that there is something wrong with that). 

Assumptions often exist that all relationships are monogamous and between only two partners, which can result in patients feeling marginalized, not returning to a healthcare provider or avoiding healthcare providers overall, and can also lead to oversights in what types of care are relevant to a given patient. Polyamorous and non-monogamous relationships may both involve someone having multiple sexual/romantic partners, but the relationship structures and commitment levels among partners are typically different between the two. This information should only be asked if relevant to the care being provided. For instance, a provider may ask for this information in order to assess whether conversations about relationship agreements are needed (e.g., agreements related to sexual practices with outside partners, STI testing agreements, etc.). 

If this information is not relevant to your practice do not include these questions. If you need to know about who can care for the patient in times of need or provide social support, it is better to directly ask about that rather than making assumptions based on relationship status (use the Home/Living Status question). 

If you are asking for names or other information related to a patient’s spouse or partner(s), refer to them as “spouse/partner(s)” and provide space for details about more than one person.

A person’s relationship status and relationship structure can change over time, so you will need to integrate a process for checking for updates and updating records as needed.

Supplemental Resources:

• • Psychology Today - Basics of Polyamory:
    https://www.psychologytoday.com/us/basics/polyamory

  • American Psychological Association Task Force for Consensual Non-Monogamy:
    https://www.apadivisions.org/division-44/leadership/task-forces 

Living Situation

Home/Living Status

This question inquires about the patient’s living situation or housing status, which can be relevant to understanding housing needs and supports of patients. For instance, housing and having someone who can provide care can be relevant when recovering from some medical procedures. If this information is not relevant to your practice, do not include these questions, or only ask them when preparing for procedures in which the information is relevant. Whenever possible, these questions should be asked during a private discussion with the patient and not directly on an intake form.

If the patient indicates that their housing situation is unstable or that they are unhoused/homeless, this would be an ideal time to offer resources your clinic may have (if you are prepared to provide the information and patients are interested in it). Please refer to the Information or Resources section for guidance on doing so.

A person’s home/living status can change over time, so you will need to integrate a process for checking for updates and updating records as needed. Make sure to ask this question when someone is preparing for procedures and you need current information about housing status and having someone available who can provide care. 

Supplemental Resources:

• • National Center for Transgender Equality - Homelessness:
    https://transequality.org/issues/housing-homelessness 

  • National Center for Transgender Equality - Making Shelters Safe for Transgender Evacuees:
    https://transequality.org/issues/resources/making-shelters-safe-transgender-evacuees

Resources

Information or Resources

Some patients may have unstable housing or food access, may be experiencing domestic or sexual violence, or may be questioning their gender or sexual identity. If your office is prepared to offer resources, information, or referrals on these topics, adding a question to your forms that specifically asks if they would like relevant information allows people to request it. Whenever possible, these questions should be asked during a private discussion with the patient and not directly on an intake form.

Do not include questions asking if patients would like information or resources if you and your staff are not properly trained to answer questions from patients about those topics or are not prepared to offer appropriate resources. Training is critical, as topics like gender and sexual identity, domestic and sexual violence, unstable housing or food access, etc. can be extremely sensitive, and saying the wrong thing can be worse than not saying anything, particularly if you are a trusted source of information.

Many people may be unsure of where to get relevant or trustworthy information on those topics, and your office can help. Additionally, particularly for those experiencing domestic or sexual violence, it may not be safe for them to seek out information at home (for example, their abusers may monitor their Internet and phone use), and your office may be a safe place for them to get information or discuss the issue. While you can make a huge positive difference in someone’s life by being able to offer information and assistance, it should be taken as a serious responsibility that requires training and ongoing learning.

There are two ways to ask this question: 1) a single question with multiple choice options for what information the patient would like or 2) follow-up questions to existing questions on the same topic. For example, if you have a question about housing status with an option for unstable housing, a checkbox can be added below that option to allow the patient to request information. Do not expand the list without consulting with appropriate experts, as some terms may be considered derogatory or offensive, and undermine efforts to help.

Supplemental Resources:

• National Center for Transgender Equality - Homelessness:
  https://transequality.org/issues/housing-homelessness 

Emergency Contact Information

Emergency Contact and Message Information

The person or people that a patient lists as their emergency contact may not know the name they go by or their gender, and may instead only know what they were assigned at birth or what is on record in other places. They may also only know the name they go by and their gender, and not what they were assigned at birth or is on record in other places. The same issues arise for people who may have access to a patient’s voicemail or email used to leave messages. For many trans and nonbinary people, having family members, coworkers, or others find out the name they go by, their gender, or their sexual identity may cause them to lose their home, their job, or may cause other problems for them. For example, trans people have a significantly higher rate of homelessness than cisgender people, in part due to being thrown out by unsupportive family who they come out to or who otherwise find out that they are trans. 

For others, the emergency contact listed may only know the name they go by and their actual gender, and may not know their legal name or the gender assigned at birth, and may not know that they are trans. Revealing the legal name or gender assigned at birth of a trans or nonbinary person can also put them at risk, and may result in a variety of other painful or difficult situations for them. Do not disclose information about a patient that is not needed. Whenever possible, these questions should be asked during a private discussion with the patient and not directly on an intake form.

It is important to give patients the ability to specify what name, pronouns, and other information should be used when referring to them with emergency contacts. No other name, pronoun, or gender information should be disclosed to emergency contacts unless it is absolutely necessary (e.g., to provide the ability to contact them in a hospital). If a patient provides different information to use with emergency contacts, have a discussion with them about situations in which the use of other information may be necessary.

The name, pronouns, and honorific to use with an emergency contact should be asked for immediately after asking for the emergency contact’s name, phone number, etc. and must be asked for separately for each emergency contact. Do not assume that all emergency contacts know or use the same name, pronouns, etc. for the patient.

The name, pronouns, and honorific to use in voicemails, emails, text messages, and other  communications should be asked for immediately after asking for consent to use those types of communication with the patient (or immediately after asking for contact information, if consent is not asked for).

Avoid using gendered terms or assumptions when asking for the name or other information about emergency contacts (e.g., use “sibling” instead of “brother or sister” and provide “parent” as an option instead of or in addition to “mother” and “father”). If asking about a patient’s spouse or partner(s), refer to them as “spouse/partner(s)” and provide space for details about more than one person.

Communication preferences can change over time, so you will need to integrate a process for checking for updates and updating records as needed.

Supplemental Resources:

• • The Trevor Project: Youth Homelessness:
    https://www.thetrevorproject.org/get-involved/trevor-advocacy/homelessness/ 

  • True Colors United:
    https://truecolorsunited.org/our-issue/ 

  • National LGBTQ Task Force: Why Outing Can Be Deadly:
    https://www.thetaskforce.org/why-outing-can-be-deadly/ 

  • 2015 U.S. Transgender Survey: Michigan State Report:
    https://www.transequality.org/sites/default/files/docs/usts/USTSMIStateReport%281017%29.pdf 

Glossary

This is a brief list of terms that align to the above content. This is not meant to be exhaustive. There may be additional terms that you are not familiar with and we encourage you to look these up using the resources at the end of this Glossary. Avoid using any identity labels (e.g., agender, bisexual, nonbinary, transgender) solely as nouns (i.e., “We care for gays”). Instead, use the terms as adjectives (i.e., “We care for gay patients”). 

Agender: Someone who identifies as not having a gender or as having a neutral gender (there is variability in the meaning and experiences of gender for agender people). 

Aromantic (Aro): This is a romantic orientation identity label referring to someone who has no or very little desire for romantic relationships. This should not be confused with “asexual” which refers to the lack of sexual attraction or sexual interest, though the two terms are often used together (i.e. someone who is aro ace or aromantic asexual is someone who does not desire sexual or romantic relationships with others).

Asexual (Ace): This is a sexual orientation identity label indicating no or low levels of sexual interest in others. It does not imply that a person does not have sex or does not enjoy sex. This also does not mean that a person is not romantically or emotionally interested in others. Some common sub-categories or associated terms include like grey-asexual/greysexual and demisexual. 

Bisexual: This is a sexual orientation identity label most often used to indicate romantic, emotional, and/or sexual attraction to people of multiple genders. For many people, this term is synonymous with “pansexual,” but others draw a distinction. This does not necessarily imply anything about a person’s full attraction to others or their sexual behavior, as it is an identity label only. A person who is bisexual can have partners of only one gender or of any gender—they are still bisexual, regardless of their current or past relationships, if this is how they identify.

Cisgender: Someone whose gender identity aligns to what is typically socially associated with their sex assigned at birth. For instance, a cisgender woman is someone who was assigned female at birth and identifies as a woman. 

Gay: This is a sexual orientation identity label most often used to indicate romantic, emotional, and/or sexual attraction between two men. However, sometimes this is used to indicate a broader non-heterosexual identity and is a term that people may use regardless of their own gender identity. “Homosexual” is a more outdated term that has been used in the past and should be avoided, as it has taken on negative connotations (do not use it to refer to a patient unless it is a term that they specifically indicate that they use). The term “gay” does not necessarily imply anything about a person’s full attraction to others or their sexual behavior, as it is an identity label only. 

Gender Identity: Someone’s internal sense of their gender, which may or may not align with assumptions based on their sex assigned at birth, anatomy, or appearance. Some examples of gender identities include woman, man, non-binary, genderqueer, and additional terms.

Intersex: This is an umbrella term used to refer to individuals whose anatomy is outside of what is typically designated as male or female at birth, due to differences related to external genitalia, internal reproductive organs, chromosomes, or other sex characteristics. You may also hear the term “differences of sex development” used interchangeably with intersex. “Intersex” and “nonbinary” are not interchangeable terms, and do not mean the same thing. Some people may explicitly identify with the term intersex as an identity term, whereas others may not. 

Lesbian: This is a sexual orientation identity label most often used to indicate romantic, emotional, and/or sexual attraction between two women. This does not necessarily imply anything about a person’s full attraction to others or their sexual behavior, as it is an identity label only. 

Name You Go By: The name that someone uses in day-to-day life. Many trans and nonbinary people use a name that does not match the one they were given at birth (often instead using one that they feel better fits their gender identity), and while some also change their name legally, others may choose not to or may encounter significant hardships that prevent them from doing so. Regardless, you should always use the name a person goes by, and not their legal name when talking to them or when referring to them, unless there is a required reason why another name would need to be used. In the past, you may have heard this referred to as ”Preferred Name,” but that term is outdated and considered pejorative or insulting by many, as it implies this is a preference that can be ignored. 

Nonbinary: Someone whose gender does not align with the boxes of being a “man” or a “woman” (i.e., the gender binary) and may experience their gender as some combination of gender experiences, as shifting along a spectrum of gender, or as outside the gender binary altogether. There is great variability in what being nonbinary means to a given individual. Sometimes nonbinary is also used as an umbrella term to refer to many different identities, like genderqueer, genderfluid, and agender. Some nonbinary people will also identify as transgender and some will not. Some people who use terms like genderqueer, genderfluid, or agender do not use the term nonbinary to describe themselves. It is important to respect the terms that individuals use to describe themselves. “Nonbinary” and “intersex” are not interchangeable terms and do not mean the same thing. 

Pansexual: This is a sexual orientation identity label most often used to indicate romantic, emotional, and/or sexual attraction to people of multiple genders or regardless of their gender. For many people, this term is synonymous with “bisexual,” but others draw a distinction. This does not necessarily imply anything about a person’s full attraction to others or their sexual behavior as it is an identity label only. A person who is pansexual can have partners of only one gender or of any gender—they are still pansexual, regardless of their current or past relationships, if this is how they identify. 

Polyamorous: An umbrella term for relationships in which partners may engage in emotional, romantic, or sexual relationships with multiple people and not strictly one partner. This is a relationship structure that is mutually and consensually agreed upon by partners (i.e., it is not “cheating”). You may also hear terms like consensual/ethical non-monogamy or open relationship used to describe this type of relationship structure. The terms and agreements of any of these types of relationships will vary across people and partners, and should not be assumed. It should also be differentiated from polysexual, which is a sexual orientation identity.

Polysexual: This is a sexual orientation identity label most often used to indicate romantic, emotional, and/or sexual attraction to people of multiple genders or regardless of their gender. This does not necessarily imply anything about a person’s sexual behavior, as it is an identity label only. It should also be differentiated from polyamorous, which describes a relationship structure or practice. 

Pronouns: These are the terms that are used to refer to others without using their name, like “she” or “her.” Most people use gendered pronouns (she/her/hers or he/him/his). There are other gender-neutral pronouns like they/them/theirs and ze/hir/hirs. Some people may not want any pronoun to be used for them; others may have more than one set of pronouns that they use. It is important that people are only referred to using the pronouns they tell you to use. In the past, you may have heard the term ”Preferred Pronouns,” but this is outdated and considered pejorative and insulting by many, as it implies this is a preference that can be ignored. 

Queer: This is a sexual orientation identity label that simply means that a person is not heterosexual, and is also sometimes used to indicate inclusion in the LGBTQ+ community more broadly (e.g., for people who are not cisgender). There are many variations of experience within this umbrella term - some people may use it to indicate their attraction only to people of the same gender, whereas others will use it to indicate attraction to others of multiple genders or regardless of gender. Some people also use this term for political reasons, as it is a term that has been used against many in the community in the past and has been reclaimed. There can still be negative connotations attached to this term for some in the community, particularly in the southern United States and for individuals who are older, and it should therefore not be used to refer to someone unless they indicate that they use the term or are comfortable with it. Moreover, avoid using the word solely as a noun (i.e., “We care for queers”). Instead, use the word as an adjective (i.e., “We care for queer patients”). This term does not necessarily imply anything about a person’s full attraction to others or their sexual behavior, as it is an identity label only. 

Sex Assigned at Birth: The designation that someone is given at birth, most typically as “male” or “female,” although some states are beginning to recognize intersex individuals on birth certificates. This designation is made usually based solely on external genitalia. The term “sex assigned at birth” and terms like “assigned male at birth” or “assigned female at birth” are more affirming than terms like “natal sex” or “sex.” Sex assigned at birth is different than gender and should not be used as a proxy for someone’s gender identity. 

Straight or Heterosexual: This is a sexual orientation identity label. Most often, this is used to indicate a romantic, emotional, and/or sexual attraction exclusively between women and men. This does not necessarily imply anything about a person’s full attraction to others or their sexual behavior as it is an identity label only—meaning that someone may identify as straight but also have sex with others of the same gender. There also may be times when someone may look to others to be in a “heterosexual” relationship but identifies in other ways (e.g., a bisexual woman who is married to a man is still bisexual). 

Trans Man: Someone who was assigned female at birth and identifies as a man. Individuals may never use or may drop the prefix of “trans” and simply identify as a man. It is important to respect the terms that individuals use to describe themselves. Trans men are men; “trans” is an additional descriptive term that some people choose to include when identifying their gender, but they do not need to do so.

Trans Woman: Someone who was assigned male at birth and identifies as a woman. Individuals may never use or may drop the prefix of “trans” and simply identify as a woman. It is important to respect the terms that individuals use to describe themselves. Trans women are women; “trans” is an additional descriptive term that some people choose to include when identifying their gender, but they do not need to do so.

Transgender: An umbrella term used to refer to anyone whose gender identity differs from that typically associated with their sex assigned at birth. This is a catchall term, but whether or not an individual feels that this label fits with their experience will vary across people. Identifying as transgender, or trans, does not mean that a person will adhere to stereotypical notions of having “always known” they were trans or pursue medical care to affirm their gender. There are many barriers to medically affirming a person’s gender and desire for this care will vary across people. Many trans people seek medical interventions (e.g., surgery, hormones) and many do not. Not getting or not wanting medical interventions does not make someone less trans than someone who does. Individuals who are nonbinary, genderqueer, agender, etc. may or may not also use the term transgender to define themselves.

Supplemental Resources for Additional Definitions: 

• The ABC’s of LGBT+:
  https://www.amazon.com/ABCs-LGBT-Ashley-Mardell/dp/163353409X 

• Refinery 29 Gender Nation Glossary:
  https://www.refinery29.com/en-us/lgbtq-definitions-gender-sexuality-terms