Frequently Asked Questions

Foria’s roots are in Connect-Clinic, an Ontario-based clinic that pioneered virtual gender-affirming care. In December 2022, Connect-Clinic 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. Connect-Clinic’s Medical Director, Dr. Kate Greenaway, worked 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, Alberta, and British Columbia. Patients must be physically in Ontario, Alberta, or British Columbia at the time of their virtual consult. (Updated June 2026)

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.

To book, please visit our Booking App at https://foria-intake.web.app/.

Need help using the booking system? Check out our step-by-step guide.

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.

Patients in British Columbia can typically book an appointment within six to eight weeks for Initial Consults, Surgical Assessments and Follow Up appointments. (Last updated June 2026)

Once you have created your profile in the TELUS Health Connect app, you can access the portal using your health card number.

If you do not have a health card, we will have provided you with a unique identifier by email. To sign in, select “No Provincial Coverage” and enter the unique identifier.

If you do not have a health card but you have not been provided with an identifier number, then email us at support@foriaclinic.com.

If you have a health card, follow the instructions below.

Alberta
To log in with AHCIP, you can use your health card number and your email or phone number. Enter AHCIP numbers with the hyphen.

British Columbia
To log in with MSP, you can use your health card number and your email or phone number. Enter MSP numbers without spaces.

Ontario
To log in with OHIP, you can use your health card number and your email or phone number. Enter OHIP numbers without spaces.

The electronic medical record system we use is called Collaborative Health Record (CHR). This is the system that we use to conduct our virtual video visits as well as send pre-visit forms and secure messages. You’ll receive an email or SMS whenever a new notification is available for you.

We are currently offering services to residents of Ontario or British Columbia who are 16 years and older, and to 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.

In these cases, if you see a nurse practitioner there is still a fee for the appointment because we will still provide a detailed assessment prior to referring you on.

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 and British Columbia do not need a provincial health card to use Foria. This is because our Ontario and B.C. appointments are with nurse practitioners, who are not covered by the provincial health system.

To use Foria in Ontario or British Columbia, 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 or British Columbia 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 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

Alberta
If you live in Alberta, some forms of hormone therapy are covered through the Alberta Drug Benefit List. Coverage depends on your eligibility for a provincial drug program (such as Non-Group Coverage, Alberta Adult Health Benefit, Income Support, or Seniors Coverage) or your private insurance plan. Injectable testosterone, oral estrogen, and anti-androgens are generally covered under provincial drug plans. Topical testosterone and topical or injectable estrogen are generally not covered.

Some anti-androgens require Special Authorization before they are covered. If your prescribed medication requires Special Authorization, your Foria clinician can submit the necessary paperwork on your behalf and send the approval to your preferred pharmacy when it has been processed.

British Columbia
If you live in British Columbia, some forms of hormone therapy are covered by National PharmaCare. These are injectable testosterone, and oral and topical estrogen. Topical and injectable estrogen and testosterone, and anti-androgens are not covered.

Most residents with MSP are eligible for at least one PharmaCare plan. If you're enrolled in MSP, you're automatically covered by National PharmaCare. 

Injectable testosterone requires Special Authority, meaning the prescriber submits information showing why that medication is medically appropriate before PharmaCare will cover it. Foria clinicians can submit this form for you and send the approval to your preferred pharmacy when it has been processed.

Ontario
If you live in Ontario, some forms of hormone therapy are covered by the Ontario Drug Benefit (ODB) program. These are topical and injectable testosterone, oral estrogen and anti-androgens. Topical and injectable estrogen are not covered.

ODB includes Ontario Works (OW), the Ontario Disability Support Program (ODSP), people over 65 years of age, people under 24 years of age without private insurance (via OHIP+) and those on the Trillium Drug Program. Your co-pay (the amount you pay after your insurance coverage) will vary depending on factors like your income and the sub-program you are enrolled on.

Getting your medication covered is a different process depending on which medicines you take. Estradiol and anti-androgens are automatically covered and need no extra paperwork. Injectable and topical testosterone are covered with the submission of a form to the Exceptional Access Program (EAP). Foria clinicians can submit this form for you and send the approval to your preferred pharmacy when it has been processed.

Private insurance
Hormone therapy is also covered by some private insurance programs but this can vary. If you have private insurance, speak to your provider about coverage.

Out of pocket
If you’re paying out of pocket, this is roughly how much you can expect to pay for medications. These are based on average doses and don’t include pharmacy fees. You should contact your pharmacy directly to inquire about exact costs to you.
- Estrogen (pill) – $39
- Estrogen (patch) – $53
- Estrogen (injectable) – $40
- Anti-androgens – $13-18
- Testosterone (gel) – $67
- Testosterone (injectable) – $14-29

Connect Fund
For patients experiencing financial barriers, we partner with Connect Fund, which may be able to assist eligible individuals with medication costs.

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.

No. Foria appointments need to be paid in advance, but you can pay for these one at a time.

When you begin hormone therapy with Foria, you will need multiple appointments. The number and type of appointments will vary depending on if you’re starting hormones for the first time or transferring your care to us. To learn more about the intake process, visit https://www.foriaclinic.com/resources/your-foria-journey/.

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.

Labs send reports directly back to our clinic since we are the ordering clinic/clinician. However, lab reports are also made available through CareConnect – this means all lab reports for a patient are visible to any provider reviewing your lab results through that system regardless of ordering clinic/clinician. Other providers may also be able to see your prescriptions through CareConnect.

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.

Surgical assessments must be done before 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.

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.

Once your Prior Approval Form has been reviewed and approved, 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.

We are not allowed to refer to more than one surgeon at a time. We can, however, withdraw your referral to one surgeon and re-refer to another. If you would like to do this, please reach out to us at support@foriaclinic.com.

Yes. If your clinician deems it appropriate, they will provide a gender dysphoria diagnosis during your surgery assessment. This is because it’s required by surgeons and the Ministry of Health, if you're applying for coverage.

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, British Columbia, and Alberta. You can also get your prescription filled at any pharmacy of your choice.

For patients in British Columbia, some prescriptions must be filled at a pharmacy of your choice in B.C. Depending on the pharmacy you use, they may be able to deliver medications.

Generally, our clinicians may write prescriptions for three months, six months or one year at a time. How much of the medication you’re able to receive at once will depend on your pharmacy and how much they have in stock. For longer prescriptions, they may dispense your medication in instalments if inventory is running low.

No. To renew your prescription through us, you’ll need to book an appointment with one of our clinicians. This is so that we can ensure you’re healthy and the medication is working well. If you’re interested in proceeding with Foria and are eligible to receive care, you can book an appointment at https://book.foriaclinic.com/

If you don’t want to book an appointment with us, you may be able to receive a renewal through a local walk-in clinic. However, this is at each clinic’s discretion. We suggest contacting clinics directly to check if this is a possibility before going in person.

Foria clinicians will send you a requisition for lab tests through a secure message in the TELUS Health Connect app. This is a document that tells a lab what tests are being ordered and where to send results to. How long you have to wait to get blood work will depend on your location and labs in your area.

Alberta
Laboratory testing is provided through Alberta Precision Laboratories (APL). We recommend booking your appointment ahead of time as availability can vary by location and demand. You can book your appointment here [https://qme.albertaprecisionlabs.ca/].

British Columbia
In most areas of British Columbia, you can take your printed requisition to LifeLabs for testing. While many locations accept walk-ins, some recommend or require appointments. We suggest checking your preferred location's requirements before you visit and booking an appointment if needed.

Ontario
In most Ontario cities, you can usually take your printed requisition to a lab and have your tests completed the same day. Many labs also accept requisitions by email, although it's a good idea to confirm the process with your chosen location in advance. Common labs include LifeLabs and Dynacare.

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

If we’ve sent your prescription to your preferred pharmacy but they haven’t received it, get in touch with us at support@foriaclinic.com. Sometimes there can be glitches with faxes - we can re-send your prescription, which usually goes through. If it still hasn’t been received then let us know.

If your pharmacy doesn’t have your medication or injection supplies but they usually stock it, you can ask them to check other branches where it may be available. They can usually direct you to somewhere that has a supply, or can let you know when they’ll restock if you’re able to wait. If your pharmacy doesn’t have your medication and doesn’t stock it, you can ask if they would be able to order it in for you. If not, you will have to find an alternative pharmacy. It’s a good idea to try a different pharmacy brand (e.g. Shoppers, Rexall). If you call instead of visiting in person this can save you time.

Maybe! This will vary depending on your individual situation. We will need to review your records first, so we can't make any guarantees until we see them. We'll definitely do our best to get you further along in the process.

If this applies to you, email us directly at support@foriaclinic.com. If you already have a copy of your records, you can email these to us if you are comfortable with that. Please note that email is a less secure form of communication – in your message to us, please indicate that you are aware of this and consent to sharing medical information through email.

If you do not have copies of your records or you are not comfortable using email, you or your provider(s) can also fax a copy of your records to us at +1 (437) 317-9843.

In addition to your hormone therapy, you’ll need:

• 1mL syringes

• 18g needles to draw up your hormone therapy (1-1.5 inch length)

• 23g needles for intramuscular injections (1 inch length)

• 25g needles for subcutaneous injections (5/8 inch length)

• alcohol swabs for cleaning the hormone vial and your skin

There are multiple options for where to get needles. Depending on how urgently you need them, you can order online or pick them up in person. There are also different price points depending on the supplier (some are free!).

Pharmacies. You can usually buy one or two needles at a time from most pharmacies. These are the most expensive option ($1-2 each) but can be useful if you need one immediately. If you would like, our clinicians can write you a prescription for these (which can be covered by a health spending account, if you have private insurance with one).

Online medical suppliers. These are cheaper than pharmacies and sell injection supplies in bulk. They can be convenient if you are in a rural or remote area, because they will deliver directly to you. Two options are Starkman’s and Emerdepot.

Harm reduction sites. These services are designed for people who use drugs, but anyone can use them. They provide injection supplies for free and may have healthcare workers present. Find a site near you in:

• Alberta

• British Columbia

• Ontario

Alberta
You don't need a physician or nurse practitioner's documentation to change your ID in Alberta. Skipping Stone [https://www.skippingstone.ca/id-clinics] has resources and clinics to support you.

British Columbia
In British Columbia, you can update the gender marker on your ID directly. Trans Care BC [https://www.transcarebc.ca/explore-transition/id-change] has clear, step-by-step guidance to walk you through the process.

Ontario
Foria can provide a gender marker change letter for our Ontario patients. You can ask your clinician during your appointment, or you can send an email to support@foriaclinic.com. This service is free.

Service Ontario requires a hard copy letter signed by a doctor. Foria will prepare this letter and have it signed by our Medical Director, Dr. Kate Greenaway. We will then send it to you via post, so you can submit the letter yourself.

To prepare your letter, we’ll need some information from you. We will send an email with a link to our online questionnaire where you can give this to us. We will send you a secure message once we have sent this letter to you, so you can look out for it!

Your letter should arrive in a week or so. If you haven’t received it after that point, send us an email at the address above.

Yes! We can provide a travel letter. This letter will confirm that the medication is prescribed for you. Your clinician will send your letter through a secure message.

We recommend checking directly with your airline to confirm their protocol for travelling with medication. Hormone therapy should be no different to any other medication, as long as it is in the original container or packaging with your name and your prescriber information listed.

Some countries may be hostile towards trans, non-binary and gender-diverse people. Before travelling, we recommend checking the law relating to 2SLGBTQ+ people in your destination. In some cases you may have to be discreet for your own safety.

We recommend checking directly with your airline to confirm their protocol for travelling with medication. Hormone therapy should be no different to any other medication, as long as it is in the original container or packaging with your name and your prescriber information listed.

Some countries may be hostile towards trans, non-binary and gender-diverse people. Before travelling, we recommend checking the law relating to LGBTQ2S+ people in your destination. In some cases you may have to be discreet for your own safety.