Request a Top Surgery Recovery Pack
This form is for requesting a Surgery Recovery Pack for top surgery (mastectomy). If you would like to request a pack tailored to your needs after having lower surgery/surgeries (vaginoplasty or similar) please click here:
If you are a trans, intersex, or nonbinary (TIN) person having any other gender or sex affirming surgery/surgeries, please email us at firstname.lastname@example.org and we will work with you to create a pack that is suitable to your specific needs.
Due to our budget, we are currently able to provide an average of 2 full surgery packs per month. Please don't let this deter you from requesting one or asking for the items you feel you need. We will do our best to fulfil community needs where we can, and we may be able to provide your with some of the items you requested, or a full pack next month instead!
All the information you provide in this form is confidential and will only be shared with other members of the TAC team who are working on putting the surgery packs together. If you have not been a service user or volunteer of Trans Aid Cymru before, we may ask you some questions or ask you to provide evidence before approving your pack.
Sign in to Google
to save your progress.
Please tell us your name and pronouns
Please provide an email address so that we can contact you. If you don't have or don't often use an email address, please tell us your phone number, or twitter or instagram.
Please tell us your address
This information will not be shared with anyone other than the TAC team members working on the surgery recovery packs. Some items in the pack may be posted directly to you. If it is unsafe to send items directly to you, please provide an alternative address of someone you trust who you can pick the items up from. Unless you specify otherwise, all items will be addressed to the name you provide on this form.
Please tell us the date you are leaving for your surgery.
We don't need to know the exact date of your surgery, but we do need to know when you are leaving to travel to the city where you are receiving your surgery. If, for example, your surgery is on the 18th but you are leaving for London on the 14th, we need to make sure all items are delivered before the 14th so that you have everything ready. If you are not sure yet of the exact date, select the date that is most likely so that we have some idea of what our deadline is.
Please describe below any allergies or intolerances you have, including food allergies:
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service