T4T Caregiving Contact Form

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Please use this form to request a consultation for caregiving services!

Hello! What's your name? *

Please list the name that you go by - this does not need to be your legal name.

Your pronouns *

Email *

This is how we will contact you, so please double check spelling!

What type of gender-affirming surgery are you having? *

Surgery date

YYYY

Surgeon's name

Location of surgery *

City, State

In which hospital or surgery center will your procedure take place?

Will you have a hospital stay after your surgery? If so, for how long?

Dates you're seeking care *

If you're unsure, we can make a recommendation during your consultation.

Will you be staying at home or in a short-term rental/hotel during your recovery? *

I live locally to my surgeon and will be staying at home

I will book (or have already booked) a short-term rental (i.e. Airbnb) or hotel

Other:

Are you seeking live-in caregiving or drop-in visits only?

*Live-in caregiving is typically required for genital surgeries, and sometimes for other procedures.

*Drop-in visits are only available in locations where we have local caregivers - San Francisco Bay Area, San Jose, San Diego, Los Angeles, Seattle, New York City, Philadelphia, Atlanta, Nashville (TN), Fort Collins (CO), and Milwaukee (WI). Drop-in availability is limited.

I am seeking a live-in caregiver for my recovery

I am seeking drop-in caregiving visits in one of the listed areas

Other:

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