The impact of smoking, drugs, and alcohol on surgery and surgical outcomes. The importance of aftercare related to post-operative complications and aesthetic outcomes. The mandatory education/preparation program for genital surgery. Sterilization and reproductive choices. (Genital surgeries only) Is your client's gender identity stable? Yes No Do you believe your client has realistic expectations about what each surgery requested can and cannot do physically and psychologically? Yes No Do you have any hesitation or concern that the client may regret or not benefit from a surgical intervention at this time? Do you believe your client has realistic expectations about recovery and post-operative care ? Yes No Is there anything you would like to add? Click here to enter text. Your name, title and license: Click here to enter text. Your signature: _______________________________________ Date: Click here to enter text. Your phone number for follow up: Click here to enter text. Please print out this form and sign it. Fax it to: 415-355-7407
The impact of smoking, drugs, and alcohol on surgery and surgical outcomes. The importance of aftercare related to post-operative complications and aesthetic outcomes. The mandatory education/preparation program for genital surgery. Sterilization and reproductive choices. (Genital surgeries only) Is your client's gender identity stable? Yes No Do you believe your client has realistic expectations about what each surgery requested can and cannot do physically and psychologically? Yes No Do you have any hesitation or concern that the client may regret or not benefit from a surgical intervention at this time? Do you believe your client has realistic expectations about recovery and post-operative care ? Yes No Is there anything you would like to add? Click here to enter text. Your name, title and license: Click here to enter text. Your signature: _______________________________________ Date: Click here to enter text. Your phone number for follow up: Click here to enter text. Please print out this form and sign it. Fax it to: 415-355-7407