I will always make space for people over 18 who need a

 letter to access gender-affirming medical care.

 I use the ​informed consent framework for writing letters and  

typically require only one appointment.

 I realize insurance companies and surgeons have requirements for letters 

and I want to help you deal with the gate-keeping

 by providing a letter in the least harmful way possible. 

You will leave the appointment with the signed, completed letter in hand. 

I can charge your insurance or accept private pay for the appointment and will never charge additional fees for the letter, including if you need me to make changes to your letter for whatever reason. 

More info about informed consent care and gatekeeping: 

https://journalofethics.ama-assn.org/article/informed-consent-medical-care-transgender-and-gender-nonconforming-patients/2016-11

https://icath.info