. Author manuscript; available in PMC: 2018 Aug 1.

Published in final edited form as: Anesth Analg. 2018 Aug;127(2):359–366. doi: 10.1213/ANE.0000000000003371

Table 2.

Collection of Gender Identity on a Patient Intake Form

1. What is your current gender identity? (check and/or circle all that apply)
□ Male
□ Female
□ Transgender male/transman/FTM
□ Transgender female/transwoman/MTF
□ Genderqueer
□ Additional category (please specify):__________
□ Decline to answer

2. What sex were you assigned at birth? (check one)
□ Male
□ Female
□ Decline to answer

Adapted from the University of California San Francisco, Center of Excellence for Transgender Health.

Abbreviations: FTM, female to male; MTF, male to female.