<Your full name>
<Address>
<Email>
<Phone>

<Health or medical setting>
<Contact name>
<Address>
<Email>
<Phone>

To whom it may concern,

I am writing to inform you that [my son / my daughter / the young person] — who you previously knew as <insert young person’s previous name> is gender diverse.

[Her / His / Their / <Other>] gender identity does not align with the [female / male] gender [she / he / they / <other>] were assigned at birth. [She identifies / He identifies / They identify / <other>] as <gender identity>, which means their gender is [female / male / a mix of female and male / neither female nor male / <other description>].

Request to change record of personal details

[She is / He is / They are / <Other>] currently on record with you as: <Young person’s previously listed name>
[Her / His / Their / <Other>] preferred name is: <new name>
[Her / His / Their / <Other>] personal pronouns are: [She/Her/Hers / He/Him/His / They/Them/Their / <Other>]
[Her / His / Their / <Other>] legal name is: <legal name>

I would like to request that [her / his / their / <other>] details be updated in your records accordingly.

[I enclose a certified copy of <Name>’s new Birth Certificate / Change of Name Certificate / An updated Birth Certificate has been ordered and will be supplied to you once received.]

Responsibility to provide safe, gender-affirming care

If they have not had previous experience treating young transgender, gender diverse, and non-binary people, we trust that <Name>’s doctor and other professionals who will be treating [her / him / them / <other>] will make a concerted effort to familiarise themselves with the following materials:

• Australian Standards of Care and Treatment Guidelines: For trans and gender diverse children and adolescents | Royal Children’s Hospital Melbourne (2002)
• Journey to Care: GPs can be a key part of a transgender patient’s pathway to whole-of-person healthcare | RACGP (2017)

I also trust that staff will make their best efforts to use <Name>’s correct name and pronouns at all times, and that if any person notices another staff member using an incorrect name or pronouns, to please correct that person immediately. We understand this is an adjustment that can take time to get used to and understand that mistakes can happen. In this case, a simple and sincere apology to <Name> will be most appreciated.

I request that, in line with federal legislation, <Name> has the freedom to access the [female / male / disabled / staff] toilet facilities and be kept safe from questions or harassment from staff when doing so.

To help you understand and affirm <Name>’s gender identity, you can also visit the following links:

• Writing Themselves In 4 | The health and wellbeing of LGBTQA+ young people in Australia La Trobe University (2021)
• Concerns for Trans Clients | The Gender Centre Inc
• Trans Pathways: The mental health experiences and care pathways of trans young people  | Telethon Kids Institute (2017)

If you have any questions, please contact me at <your phone number and email>.

Thank you for your understanding. I look forward to working together to support <name>’s mental health and wellbeing during [her / his / their / <other>] gender transition.

<your signature>

<your full name>