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What is your date of birth?
   
 
 
 
Which sex was recorded on your birth certificate?
 
male
 
female
 
 
 
when did you change your name
   
 
 
 
how many relationships did you have before and after treatment
   
 
 
 
when did you change your name?
   
 
 
 
did you take hormones before you changed your name?
 
yes
 
no
 
 
 
are you religious
 
yes
 
no
 
 
 
did you grow up in a religious home
 
yes
 
no
 
 
 
 in what type of relationships are you interested?
 
monogamous
 
polygamous
 
none
 
 
 
did you ever plan to have children?
 
yes
 
no
 
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