You can open the Top Surgery Therapist Letter Template in multiple formats, including PDF, Word, and Google Docs.
Top Surgery Therapist Letter Template Printable | Editable FormSample
Examples
[Client’s Full Name]
[Client’s Date of Birth]
[Client’s Address]
[Client’s Phone]
[Client’s Email]
[Therapist’s Name]
[Therapist’s Qualification/Title]
[Therapist’s License Number]
[Therapist’s Address]
[Therapist’s Contact Information]
I am writing this letter to confirm that [Client’s Full Name] has been under my care since [Start Date] for therapeutic treatment related to gender dysphoria. This letter serves as a formal recommendation for the client’s top surgery.
During our sessions, we have explored the Client’s feelings regarding their gender identity, body image, and the impact of these on their mental health. [Provide a detailed assessment of the client’s state, their struggles, and progress.]
The therapeutic journey for [Client’s Full Name] has focused on the following goals: [List specific goals such as improving self-acceptance, preparing for surgery, coping strategies, etc.].
After careful consideration and assessment of [Client’s Full Name], I confidently recommend that they proceed with top surgery. I believe this procedure is a vital step towards their well-being and self-actualization.
I affirm that [Client’s Full Name] meets the requirements set forth by the WPATH Standards of Care and is ready to proceed with the proposed surgery. I am available for any further information or clarification as needed.
[Signature of the Therapist]
[Name of the Therapist]
[Date]
[Client’s Full Name]
[Client’s Date of Birth]
[Client’s Address]
[Client’s Phone]
[Client’s Email]
[Therapist’s Name]
[Therapist’s Qualification/Title]
[Therapist’s License Number]
[Therapist’s Address]
[Therapist’s Contact Information]
This letter is written on behalf of [Client’s Full Name], who has been undergoing therapeutic treatment with me since [Start Date] to address gender dysphoria. I wholeheartedly support their desire to pursue top surgery.
Throughout our sessions, we have addressed critical issues related to [Client’s experiences, feelings, and actions that have led them to seek surgery]. [Detail the length and depth of the therapeutic relationship and its relevance to their transition process.]
[Client’s Full Name] has demonstrated significant progress toward their therapeutic goals, including [Specify progress, such as improved self-esteem, coping mechanisms, etc.]. I believe they are well-prepared for the challenges and benefits of top surgery.
Based on my clinical judgment and the guidelines set forth by WPATH, I recommend that [Client’s Full Name] be approved for top surgery, as it is crucial to their mental health and overall quality of life.
I am confident in my recommendation and am happy to provide further information or answer any questions regarding [Client’s Full Name]’s readiness for surgery.
[Signature of the Therapist]
[Name of the Therapist]
[Date]
Format
Please complete the form below to create the Top Surgery Therapist Letter Template. All fields must be filled out to ensure a clear and complete letter. We provide examples to guide you through each step. Top Surgery Therapist Letter Template 1. Therapist Information 2. Client Information 3. Letter Purpose 4. Client Background 5. Clinical Assessment 6. Recommendations 7. Therapist’s Credentials 8. Confidentiality Notice 9. Client Agreement 10. Declaration and Signatures
PDF
WORD
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Top Surgery Therapist Letter Template Printable | Editable FormPrintable
