Form

Form T452: Medical report for gender recognition

If you’re a registered medical practitioner or psychologist, fill in this form to support someone’s application for a Gender Recognition Certificate.

Documents

Medical report form for gender recognition (includes guidance)

This file may not be suitable for users of assistive technology. Request an accessible format.

If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email hmctsforms@justice.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

Details

The Medical Report section of the gender recognition certificate guide explains broadly what the Gender Recognition Panel needs to be told when deciding to grant a certificate.

But this form asks for more detail in parts 11 and 12.

Part 11

In your answer, include:

  • the diagnosis
  • when the diagnosis was made
  • who made the diagnosis
  • the main evidence used to make the diagnosis
  • details of non-surgical treatment to date (such as hormone treatment)
  • what medication was prescribed and when
  • planned non-surgical treatment
  • date of referral for surgery or reasons why a patient hasn’t been referred

If you didn’t make the original diagnosis of gender dysphoria, confirm the diagnosis and list your evidence for confirming.

Part 12

You should:

  • state whether gender reassignment surgery has been carried out
  • list each distinct surgical procedure
  • give the date for each procedure
  • do the same for any planned procedures
Published 1 October 2014
Last updated 25 May 2018 + show all updates
  1. We added more detail about the information you need to give in parts 11 and 12 of the form.
  2. First published.