Frequently Asked Questions

Foria’s roots are in Connect-Clinic, an Ontario-based clinic that pioneered virtual gender-affirming care. In December 2022, Connect had to stop services following the Government of Ontario’s changes to virtual care billing codes, making its operations unsustainable. These changes left 1,500 patients without access to critical life-affirming care and nearly 2,000 prospective patients on its waitlist. PurposeMed has worked with Connect’s Medical Director, Dr. Kate Greenaway, to build a new home for the clinic and its patients. That home is Foria.

Virtual gender-affirming care provides you with the safety of meeting an experienced nurse practitioner from your location. For some people, in-person care might be a better choice, and if so, your nurse practitioner will discuss this with you.

Foria is currently available in the Canadian provinces of Ontario and Alberta. Patients must be physically in Ontario or Alberta at the time of their virtual consult. (Updated September 2023)

Foria has launched in Ontario and Alberta, with plans to expand thoughtfully to other provinces.

Foria provides virtual consultations for health and wellness support, gender-affirming hormone therapy, surgical referrals, letters for gender marker change and more to trans, non-binary and gender-diverse people.

You can access Foria’s services directly from our website at foriaclinic.com. You’ll be able to learn more about the services we offer and choose what will best serve your needs. You do not need a doctor’s referral to book an appointment with Foria.

You'll need the following to access your virtual appointment:

• A supported computer or mobile device with a web browser, camera, good quality speakers, and microphone

• An internet (wi-fi) or a phone data plan (for connections via mobile device)

• A strong internet connection

• An email account. You will receive an email 5 minutes before the appointment, with a link and code to join the visit.

The frequency of your appointments will depend on the type of service you’re receiving. For more information on the frequency of appointments, visit our specific services pages:

• Testosterone

• Estrogen

• Surgical assessments & referrals

There is no waitlist to join Foria - if you meet our eligibility criteria below, you are welcome to book an appointment.

Patients in Ontario can typically book an appointment within 3 weeks for Initial Consults or Surgical Assessments, or 1 week for Follow Up appointments.

There is limited availability in Alberta right now as we have moved to a physician-based model, allowing for appointments to be free with a valid health card. We are working to add more physicians and up-to-date availability can be found on our booking site at this time. (Last updated February 2024)

We are currently offering services to residents of Ontario who are 16 years and older and residents of Alberta who are 18 years and older. We are planning to expand our operating provinces and age eligibility in the future.

There may be some reasons such as other health conditions that would make it safer for you to receive ongoing care from an in-person or specialist service. Your clinician will discuss this with you at your first appointment.

Please note: Because we will still provide a detailed assessment prior to referring you on, the fee for this service will not be refundable.

We are currently offering services to individuals 16 years and older in Ontario only, and we are working to expand age eligibility in the future.

If you live in Alberta, you will need a valid Alberta health card to use Foria. This is because your appointments are with a physician and they are covered by the provincial health system.

Patients in Ontario do not need a provincial health card to use Foria. This is because our Ontario appointments are with nurse practitioners, who are not covered by the provincial health system. For more information on why we charge in Ontario but not Alberta , check out our "Fees & Financing" page.

To use Foria in Ontario, you will still need a government-issued ID (federal or provincial). For a full list of IDs we accept, see "What if I don't have a provincial health card or identification?" in this FAQ.

In Alberta, we are unfortunately only able to serve patients with health cards. This is because Foria appointments in Alberta are with a physician, which is covered by the provincial health system.

For Ontario patients, you do not need a provincial health card to access our services, but you do need a government-issued ID (federal or provincial). You must also be physically located in the province of Ontario at the time of your appointment.

Here are a list of valid identification cards you can use:

• Health card issued by a Province or Territory in Canada

• Valid Driver’s Licence or Temporary Driver’s Licence (issued by Ontario or other jurisdiction)

• Ontario Photo Card

• Birth Certificate from a Canadian province or territory

• Government-issued Employee Identification Card

• Ontario Outdoors Card

• BYID (age of majority card)

• Certificate of Indian Status

• Valid Passport – Canadian or other country

• Certificate of Canadian Citizenship

• Canadian Immigration Identification Card

• Permanent Resident Card

• Old Age Security Identification Card

• Canadian Armed Forces Identification Card

• Royal Canadian Mounted Police/Provincial/Municipal Police Identification

• Firearms Possession and Acquisition Licence

No, you do not need a referral to access Foria.

No, you do not need a family doctor to access Foria’s services.

In 2022, Ontario dramatically reduced how much physicians can be reimbursed for providing virtual care. At the time, Connect-Clinic was a virtual clinic delivering gender-affirming care across the province. The funding changes meant that Connect-Clinic could not continue operating.

Dr. Kate Greenaway – founder of Connect-Clinic – joined PurposeMed to launch Foria, which provides this virtual care to patients in Ontario. Ontario's changes mean a virtual clinic like Connect-Clinic or Foria needs additional funds to operate, and these operational costs are passed on to patients in the form of fees. However, Ontario legislation prevents physicians from charging for services that are covered by the province. Since the province drastically reduced but did not fully remove coverage for virtual care, Foria cannot charge patients to see Ontario physicians.

To deliver our virtual service in a sustainable way, Foria's Ontario clinicians are nurse practitioners who are not covered by OHIP. Foria's nurse practitioners are paid a full-time salary by PurposeMed, so they can focus on providing high-quality care. Unfortunately, this means our services are out-of-pocket for Ontario patients at this time.

Alberta's healthcare system is set up differently. In Alberta, the province still reimburses physicians for virtual care at a sustainable rate. This means that Foria can use Alberta-based physicians to see Alberta patients, and their fees are covered by the province. As a result, Foria's services are provided at zero cost to our Alberta patients. 

You will be charged at the time of booking your appointment using our booking system.

The appointment fees will depend on the type of service you’re receiving. For more information on fees for specific types of appointments, visit our services pages:

• Testosterone

• Estrogen

• Surgical assessments & referrals

Included in all appointment fees are the following:

• A review of your medical history

• Monitoring of your health including vitals and blood work

• Sexual health monitoring and check-ins

• Management of secondary effects

We are currently working on a financial assistance program and will launch this later in 2024. This program will take the form of a fund, named The Connect Fund, that will support costs for gender-affirming care not covered by public health systems. If you are interested in this program, please opt-in to updates when you fill out your intake. (Last updated January 2024)

Credit card payments are completed via our secure online payment processor.

Foria Clinic is committed to protecting your confidentiality and privacy. The clinic adheres to strict privacy policies and complies with all relevant Canadian healthcare regulations, including the Personal Health Information Protection Act (PHIPA). For any digital communications regarding health information, Foria uses secure and encrypted platforms to ensure that your information is safeguarded.

Foria Clinic stores your medical information using a secure electronic medical record (EMR) system. This system is designed to safeguard the confidentiality and integrity of your information. The clinic adheres to Canadian healthcare data storage regulations and employs security measures such as encryption and access controls to protect your records.

Your other healthcare providers will only know that you accessed Foria’s services if you choose to share this information with them or if you provide Foria with consent to communicate with them. It’s often beneficial for your healthcare providers to have a complete picture of the care you’re receiving, but Foria respects your privacy and will not share your information without your explicit authorization, except in cases where it is legally required.

At Foria Clinic, you can request access to your health records by contacting the clinic directly at support@foriaclinic.com. There will be a $30 fee to have your records sent to you.

The clinic will provide you with information on the process and any forms that may be necessary to fill out. It’s important to know that Canadian healthcare regulations also support patients' rights to access their own medical records, and Foria is committed to facilitating this in a timely manner.

Yes, Foria Clinic utilizes a secure video platform for virtual consultations through our electronic medical record (EMR) system. The platform employs encryption and other security measures to ensure that your privacy is protected during video calls. This is in line with Canadian healthcare regulations, which mandate the use of secure and confidential communication methods in healthcare settings.

Testosterone (which some people call “T”) is a drug used in gender-affirming care. T produces changes to your body that can help reflect your gender identity. These include a deeper voice, facial hair, and more muscle mass. It also has psychological effects - it can change your sex drive and mood.

Testosterone is a hormone that’s taken by people who want to have masculinizing effects, and can also be taken by intersex people. 

For detailed information about the effects and timelines of testosterone HT, please visit our Testosterone resource page.

Yes, up-to-date lab tests are required before receiving a testosterone prescription. These tests help your clinician assess your current hormone levels and other health indicators, which are essential for determining the appropriate dosage and monitoring for potential side effects. Your healthcare provider at Foria Clinic will guide you through the necessary steps and explain the importance of lab tests in managing your hormone therapy safely and effectively.

Testosterone can be administered in several ways, including injections and topical gels. Injections can be delivered into the muscle or subcutaneously. They're taken every one to two weeks. Topicals are applied directly to the skin once per day. The method of administration that is best for you will depend on various factors including your health, lifestyle, and preferences, and should be determined in consultation with your Foria clinician.

Testosterone can be given in a range of doses. How each person responds to their dose will depend on their genetics and their response to the treatment. If you would prefer to try a lower dose, you can review this option with your clinician. Changes may be slower at low doses, but testosterone effects may be the same.

Some changes from T, like your mood or body composition, are temporary. This means that if you stop treatment they will eventually reverse.

Other changes like facial hair, bottom growth and a deeper voice are permanent. This means you can stop treatment and they will remain.
Some people choose to stop T after reaching permanent changes that they’re happy with, while others will continue for the rest of their lives. You can decide whatever works best for you and your body – and remember, you can adjust your treatment at any time.

Note: If you have had your ovaries surgically removed, then going off hormones is not recommended.

Estrogen and androgen blockers are a type of gender-affirming care. These medications have feminizing effects, and a treatment regimen usually consists of both. Androgen blockers suppress your body’s natural testosterone and estrogen is a hormone. If you’ve had bottom surgery then you won’t need to take androgen blockers. This is because testosterone is mostly produced in the testicles, which are removed during surgery.

These medications produce changes to your body that can better reflect your gender identity and/or expression. Changes include breast growth, softer skin and changes to your body fat. They also have psychological effects - they can change your sex drive and mood.

Estrogen and/or androgen blockers are typically taken by people who want to have feminizing effects, and can also be taken by intersex people.

For detailed information about the effects and timelines of estrogen HT, please visit our Estrogen resource page.

Yes, up-to-date lab tests are required before receiving an estrogen/androgen blocker prescription. These tests help your clinician assess your current hormone levels and other health indicators, which are essential for determining the appropriate dosage and monitoring for potential side effects. Your healthcare provider at Foria Clinic will guide you through the necessary steps and explain the importance of lab tests in managing your hormone therapy safely and effectively.

Androgen blockers are oral tablets, while estrogen can be administered in several ways. These include oral tablets, topical patches and injections. Oral tablets are taken by mouth, patches are applied to the skin, and injections are given into muscle or fat tissue. The choice of administration method depends on various factors including individual health considerations, lifestyle, and personal preferences. Your Foria clinician will work with you to determine the most appropriate method of estrogen administration for your specific situation.

Estrogen can be given in a range of doses. How each person responds to their dose depends on their genetics and response to the treatment. If you would prefer to try a lower dose, you can review this option with your clinician. Changes may be slower at low doses, but effects may be the same.

Some changes from hormones, like your mood or sex drive, are temporary. This means that if you stop treatment they will eventually reverse.

Other changes like breast growth are permanent. This means you can stop treatment and they will remain.

Some people choose to stop hormones after reaching permanent changes that they’re happy with, while others will continue for the rest of their lives. You can decide whatever works best for you and your body – and remember, you can adjust your treatment at any time.

Foria currently offers surgical assessments for patients in Ontario only at this time. We are working on offering this service in Alberta as soon as possible. (Last updated September 2023)

Surgical assessments must be done before OHIP-funding for a gender-affirming surgery is requested. These assessments typically include a review of gender identity, medical history, mental health, and the necessity of surgery for the patient’s well-being. 

During your surgical assessment, the nurse practitioner will review the types of surgery available, risks and benefits, and answer your questions.

In Ontario, two surgical assessments are typically required for most types of gender-affirming surgeries. Chest masculinization or breast augmentation (for those that qualify) only require one assessment. Surgical assessments are conducted by healthcare professionals with expertise in gender-affirming care, including Foria clinicians. 

Yes, absolutely. If you already have one surgical assessment, a Foria clinician can provide the second.

First you will have your surgical assessment appointment(s) with your nurse practitioner who will submit a Prior Approval Form to get your surgery funding approved. Foria will track this process for you and make sure the Ministry of Health responds.

Once your Prior Approval Form has been reviewed and approved by the Ministry of Health, your nurse practitioner will let you know this has been received and they will complete the referral to the surgeon of your choice.

For specifics on surgical referral letter appointment costs, please visit our Surgery assessment & referral letters page.

Once at a stable dosage, you can book a ‘Follow-up’ appointment when you are getting low on medication. You will then complete your lab tests and have a visit with a Foria clinician to review and renew your prescription.

To make changes to your prescription, you can book a ‘Follow-up’ appointment to discuss desired changes with a Foria clinician. Your clinician may require up-to-date lab results in order to issue a new prescription.

Yes, we have a partner pharmacy that offers free and discrete shipping to most patients in Ontario and Alberta. You can also get your prescription filled at any pharmacy of your choice.

Absolutely, to update your preferred pharmacy just let your Foria clinician know during your appointment or send an email to support@foriaclinic.com.