Sample Physician’s Letter for Passport or Social Security Gender Marker Change

Sample Physician’s Letter for Passport or Social Security Gender Marker Change

To change name and gender marker on your passport or Social Security record, you need a certified name change order, certified birth certificate, a physician’s letter, and a photo ID. The letter must be written by a medical doctor; a general practitioner, endocrinologist, or surgeon. It can NOT be written by a life coach, religious authority, social worker, or therapist.

(ON PHYSICIAN LETTERHEAD)

I, Physician’s Full Name, Physician’s medical license or certificate number, Issuing U.S. State/Foreign Country of medical license/certificate, am the physician of Name of Patient, with whom I have a doctor/patient relationship and whom I have treated (or with whom I have a doctor/patient relationship and whose medical history I have reviewed and evaluated).

Name of Patient has had APPROPRIATE CLINICAL TREATMENT FOR GENDER TRANSITION to (specify new gender male or female).

I declare under penalty of perjury under the laws of the United States that the foregoing is true and correct.

Signature of Physician
Typed Name
Date