Suggestions for Inclusive Language on Intake & Health History Forms

Instead of: Single, Married, Divorced, Single, Married, Widowed
Use: Single, Married, Diveorced/Separated, Widowed, Same Sex Partnership, Opposite Sex Partnership
Because: Many lesbians feel uncomfortable if forms
do not allow them to indicate a same-sex relationship.

Instead of: Husband/Wife’s Name, Spouse's Name
Use: Emergency Contact
Because: If the only option for an emergency contact is for a “husband, wife or spouse," many lesbian clients may assume it is unsafe to list a partner.

Instead of: Are you sexually active?
Use: Are you currently sexually active? If yes, with men, women or both? Have you been sexually active in the past? If yes, with men, women, or both?
Because: By asking "men, women or both," the provider is signaling to all patients that it is okay to discuss a variety of sexual behaviors.

Instead of: What form of birth control do you use?
Use: Do you need to use birth control?
Because: Not all sexually active women need birth control.

From the Mautner Project for Lesbian Health.