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Inclusive Intake Forms

Inclusive Intake Forms

Imagine arriving to an office or facility for a medical or related appointment, interacting with the receptionist, receiving an intake form, and already having experienced more than one trauma based on the language used when referring to you or by the information on the paper in front of you. This is the tragic reality for LGBTQIA+ and transgender or gender non-conforming folx (TGNC) when accessing healthcare. When our gender identity, pronouns, and sexual orientation are assumed of us or left out of crucial paperwork, we have already been neglected by the systems we must access. 

Under certain circumstances, one’s legal name may be required on intake forms or during the intake process for insurance or legal reasons. Though this may be necessary, it can still be traumatic and invalidating for members of the LGBTQIA+, especially TGNC folx. Often times one’s “legal name” is considered a “deadname”, a name that is no longer used by the individual in order to reclaim their identity, as a part of their personal transition, or for various other reasons. It is best to simply require one’s chosen name on an intake form, but if a legal name is required, then also leave another line to include their chosen name – the name they should be referred to as. 

Though some healthcare facilities are beginning to include pronouns on intake forms, there is still necessity for widespread use, inclusion, and normalization of pronouns. Language is a powerful tool in creating a safe space for our clients, including who they are as a whole person, and starting off on the right foot for establishing a strong and trusting therapeutic relationship. Misuse of pronouns can contribute to layers of trauma and can be perceived as direct trauma, which fractures the relationship that one has with the specific healthcare environment and can decrease the likelihood that one may access healthcare environments in general. Some common pronouns include: he/him/his, she/her/hers, and they/them/theirs, though there are other options pronouns as well. When creating an inclusive intake form, you could include check boxes for pronouns with a “fill in the blank option,” as well for an individual to list their pronouns that weren’t listed above or note that they are not comfortable sharing their pronouns. It is best and easiest for all to leave a blank line to fill in when prompted for inclusion of pronouns. 

With good intention, some healthcare environments have included the “other” option when providing options for identity on intake forms. The intention is to move beyond the binary of man/woman or male/female, however the term “other” ultimately furthers alienation of members of the community. Sit with yourself for a few minutes and empathize with what it feels like to be “other”. If you don’t feel anything, take some more time. I, a non-binary and gay person, am not “other”. I am human and my identity is valid, it is not “other”.

There are numerous simple ways to create inclusive intake forms, just by changing the language and/or formatting options. One of the easiest ways to do so is to completely remove all check boxes, including the binary options, and to leave a blank space for one to self-identify. With this example, make sure to note before the prompt that it is equally as valid to state, “I’d rather not say.” 

An inclusive intake form may look like this:


Chosen Name:________________________________________________________________________
Legal Name (if necessary):_______________________________________________________________
Pronouns:____________________________________________________________________________
Gender Identity:_______________________________________________________________________
Sexual Orientation:____________________________________________________________________
Address:_____________________________________________________________________________
(Insert any other necessary intake information)

For me, this intake form would look like:

Chosen Name: Dev Neu
Legal Name (if necessary): Devlynn Neu
Pronouns: They/Them, He/Him
Gender Identity: Non-binary
Sexual Orientation: Gay
Address: 123 Urbane Scrubs Ln, Scrub City, NY
(Insert any other necessary intake information)

It is our job as healthcare professionals to advocate for what is best for our clients. This includes honoring our patients for who they are – their identity and making sure the language we use mirrors what is best for them. Names and pronouns are not preferred nor up for interpretation, they are fact. Note that pronouns and one’s identity can shift over time and that does not invalidate who they were or give less value to who they are. The burden of communication of identity often falls to those within the LGBTQIA+ community, especially those that identity as TGNC. We as healthcare professionals can be the agents of change in the battle for recognition and inclusion. We can advocate for change of the intake forms at our places of work, so that at the first encounter a person in seen. 

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Blog Out in Healthcare

Out in Healthcare: Jonas Raider, MOTR

Name: Jonas Raider

Pronouns: He/him/his

Identity: Gay/Queer

Background: I grew up in the suburbs outside Philadelphia, and have spent the past 5 years living all over the US and Europe between grad school, travels, and a year teaching American culture in Spain. I was recommended OT by my older sister who is also an OT, and it came naturally as I wanted to find a profession that focused on helping individuals to increase their independence through collaboration and open dialogue. Outside OT, I value learning about languages, street photography, thrifting, cooking, biking, hiking, and house/techno music.

Profession: Occupational Therapist Turned User Experience (UX) Researcher

Area(s) of Practice or Interest: I love advocating for OT in non-traditional settings and paving the way for our role in areas we haven’t previously existed. Refugee resettlement, community health, and the design world are my preferred areas of practice, and I hope to continue expanding upon this and advocating for our importance!  

What does being ‘Out in Healthcare’ mean to you?: Unfortunately, many within the LGBTQIA+ community have experienced and continue to experience difficulties in accessing affirming healthcare services. Although I plan to work outside of direct client care in the healthcare sphere, being out means advocating for queer clients’ and coworkers’ voices in the design world to address more inclusive products and experiences. It also means setting an example for younger generations to see themselves represented and thriving, something I didn’t have many models of when I was younger.

What is one thing everyone should know about your identity?: Since coming out publicly at 16, I’ve been fortunate to have the opportunity to learn and grow in the ways I connect to the queer community over the years. I think it is important to realize that just like other aspects of life, your queer identity fluctuates in the role it plays! Years ago due to internalized homophobia, I would distance myself from queer people as I felt the proximity would take away from my perceived idea that living closer to a “straight passing” identity was important. Although this may work for other individuals and I in no way look down upon people who feel that needs to be an important theme intertwined with their queerness, it was liberating over the years to unlearn this perceived necessity, and just exist. My queerness is as integral to who I am as the fact that I love spending time outdoors.

How do you feel when your identity is included?: When I see other cisgender people put their pronouns in their profiles, emails, or other spaces, it makes me happy to see that it is finally becoming more of a movement. It is on us cisgender people to normalize this so that our trans and non-binary friends, coworkers, students, and clients don’t have to put in extra emotional energy to advocate for their livelihood. I feel whole when the actions of my peers allow my trans and non-binary friends to feel safe, heard, and seen.

What does “taking up space” mean to you?: Taking up space means showing up in straight spaces with confidence and remaining unapologetic in how I present my queer identity and exist. It also means constantly questioning the systems that exist that center whiteness and heteronormativity and making room for others who deserve a seat at the table. Taking up space in queer spaces means realizing the privileges I embody in being white and cis-gendered, and taking a step back to center, hear, and listen to the lived experiences of Trans, Non-Binary, and BIPOC (Black, Indigenous, People of Color) within the community.

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honor the identities of their patients?: If you’re unsure of how to interact or honor your patients, be honest with them and ask questions! Honesty in admitting when you don’t know something and a commitment to seeking out information to expand your expertise goes a long way in terms of affirming the care, safety, and trust of your clients. If you want to validate your clients, ask them what their lived experiences and preferences are, take criticism when you are corrected or informed, and go from there. 

Has your identity influenced healthcare that you’ve received?: Returning to the suburbs where I grew up to see a doctor for check ups occasionally, there have been (many) frustrating moments of internalized homophobia and unnecessary awkwardness that have been displayed by healthcare providers towards me.

Where can people find you?: You can find me on LinkedIn or contact me via email at Jonasianraider@gmail.com

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Blog Out in Healthcare

Out in Healthcare: Enrique Puentes, OTS

Name: Enrique Puentes

Pronouns: He/Him/His

Identity: Gay

Background: Both of my parents immigrated from Colombia, and I was born in Washington, D.C. I grew up in Northern Virginia but have spent the last fourteen years living in Central Florida. I have spent the past eight years working in catastrophe property insurance but have always had a longing for wanting to be in a profession that helped others improve. I finally decided to make the career transition and now am in my second term of my master’s degree.

Profession: Occupational Therapy Student (MOT)

Area(s) of Practice or Interest: I have huge interests in both Mental Health and Inpatient Rehabilitation but am unsure of where I may ultimately end up.

What does being ‘Out in Healthcare’ mean to you?: For me, being out in healthcare for me means inviting people to see my truest self. Representation of LGBT people in healthcare is important because not only does it create safe spaces for clients to feel they are being advocated for, but it also can help demystify misunderstandings that non-queer people have of the very community that I am a part of. I see being out in healthcare as a form of activism for anyone who has ever felt either marginalized in a society that has long celebrated heteronormativity.  

What is one thing everyone should know about your identity?: I want people to know that I am embracing the best possible version of myself by being out as an individual in healthcare. It is important for me to not be ‘discrete’ about my sexuality, because by me fully loving all aspects of my identity, I can in turn emanate the same level of love and care for others. 

How do you feel when your identity is included?: When my identity is included as both brown and gay, I feel included and seen as an equal amongst a group.

What does “taking up space” mean to you?: Taking up space means feeling pride about my own visibility and feeling the confidence in the fact that my visibility matters. I unfortunately did not always think/feel this way, so it’s empowering for me to live in this truth.

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honor the identities of their patients?: I think with any profession that involves interacting with all kinds of people (with varying cultures, backgrounds, political and religious beliefs, sexual orientations or gender expressions), we will almost certainly at some point, come to meet someone that we lack the education on, on how to honor and respect these individuals. Maintaining a sense of humility when engaging in these interactions is key to posturing yourself in a manner that is receptive to learning from these interactions. For healthcare professions in particular, it would behoove the practitioner to educate themselves on available resources that speaks on best care practices. Remember the importance of being client-centered in your approach and advocating for the client’s desires and wishes. 

Has your identity influenced healthcare that you’ve received?: My identity has impacted the healthcare that I have received. I have encountered practicing physicians who have not been aware of pre-exposure prophylaxis medications. It’s an odd feeling having to educate your own doctor on what this is and why you are requesting a prescription for this. I have also had experiences where healthcare professionals made assumptions of my sexual orientation. I greatly see the need for education of healthcare professions in working with LGBTQ clients.

Where can people find you?: Follow me on Instagram! (@ProudOTStudent)

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Blog Out in Healthcare

Out in Healthcare: Oliver Hoad, OTS

Name: Oliver Hoad

Pronouns: He/Him/His

Identity: Queer Trans Man

Background: I’m 23 and grew up in a coastal town on the east coast of Australia called Coffs Harbour. I am currently in the second year of my Bachelor of Occupational Therapy. I came out as bisexual when I was in high school, but as I grew into my identity I realised that queer was a better fit. I came out as trans in 2018 which was a huge change for everyone in my life but luckily it has been a mostly positive one! Where I live is fairly regional, and there is not a lot of acceptance towards the queer community so unfortunately there are not many opportunities for interaction with other queer people, especially those my age. When I’m not studying I am a member of a group for LGBTQIA+ young people, a peer educator for a sexual health organisation and enjoy gaming, baking and going to the beach.

Profession: I am an Occupational Therapy student and I teach primary school (elementary school) kids how to create video games afterschool on the side!

Area(s) of Practice or Interest: Interested in sexual health and paediatrics/adolescents.

What does being ‘Out in Healthcare’ mean to you?: Australia is not very progressive when it comes to the healthcare of transgender people. After I came out and had to go to the emergency department of the hospital I told them I was trans and that my name was Oliver yet the doctor continued to address me by my deadname* and female pronouns. Being out in healthcare would allow me to reduce the chances of this happening to other trans people, particularly youth, and would increase attendance and inclusivity within spaces that cause so much anxiety for young people.

What is one thing everyone should know about your identity?: People should know that we are not all the same and we do not have to all be the same. Not all trans people look like the stereotypical trans man or trans woman that may be portrayed in the media, and a lot of us have values and beliefs that are different from each other. That is ok and it doesn’t make someone any less trans.

How do you feel when your identity is included?: I feel hopeful for the future. The inclusion of trans people in different conversations is so important. It shouldn’t be a question whether or not to include us in conversation whether it be political, health related, in sports, or religion, and when this occurs it feels like progress is being made.

What does “taking up space” mean to you?: As queer people, we are often told that we are taking up too much space. We are told that we are too visible within the media, we should be so “gay” in public, that our stories are being told too often and we are asked why we need a whole month to celebrate our community and their history when it “isn’t necessary”. These opinions of individuals are all such negative things that are brought up way too often! However, they bring about important conversations between two communities that may not occur if our presence wasn’t questioned so often. The space that we take up is so important even if other people don’t think that it is.

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honour the identities of their patients?: Ask as many questions as possible. Ask what your patient they are comfortable with, what their pronouns are, and if they would like you to know anything about their identity. In saying that, also be respectful when asking the questions. Oh and don’t always assume that somebody fits into a binary gender simply because that is how they present!

Has your identity influenced healthcare that you’ve received?: It has definitely influenced my healthcare experience, probably being trans more than anything else. Finding a doctor who is LGBTQIA+ friendly and educated in transgender medicine is difficult in a regional area so you have to go in blind and hope for the best. There are also limited services available in these areas for transgender healthcare. In the past, I was often misgendered and called my deadname* even after telling doctors my preferred name and pronouns which is unfortunately a common problem for trans youth and people who are transitioning, especially in regional and rural areas like the one I live in. Luckily now I have found a good network of supportive doctors and allied health professionals that are educated in the needs of the LGBTQIA+ community.

Where can people find you?: You can find me on Instagram @onespicyegg or via email at olivermaxwellhoad@outlook.com

*Deadname: A deadname is the birth name of someone who has changed it. The term is especially used in the LGBTQ+ community by people who are transgender and elect to go by their chosen name instead of their given name. (Resource)

Deadnaming: Deadnaming occurs when someone, intentionally or not, refers to a person who’s transgender by the name they used before they transitioned. You may also hear it described as referring to someone by their “birth name” or their “given name.” (Resource)