LGBT Health Coalition Provider Application
Dear Provider,

First and foremost, we want to thank you for your interest in becoming a member of the Lesbian, Gay, Bisexual and Transgender (LGBT) Health Coalition. This group contains individuals and organizations from around the state with one major mission:

To develop a network of advocates and healthcare providers seeking to enhance all areas of LGBT health

And we couldn’t achieve our mission without great people from the community, including you. Before you start this application, there are a few things you should know - The LGBT Health Coalition strives to create an environment that is inclusive, without judgement and the crazy idea that all human beings deserve equal health care. If you or your practice does not believe in that ideology, please discontinue your application.

By filling out this application, you agree to the following:

1.I welcome lesbian, gay, bisexual and transgender individuals and families into my practice and offer all health services to patients on an equal basis, regardless of sexual orientation, gender identity, marital status and/or any other non-medically relevant factors.

2.I commit to taking steps to make my practice fully inclusive for lesbian, gay, bisexual and transgender persons as reflected in written forms, policies and procedures, appropriate training for all clinical and administrative staff.

3.I commit to taking steps to learn about the unique health concerns for lesbian, gay, bisexual and transgender individuals and families so that I can provide the highest quality of care to them.

How this works: After filling out this application, your application will be reviewed by the members of the LGBT Health Coalition at their next meeting. Should you be present for that meeting, you will be asked to step out while your eligibility is discussed. After approval of your application, please give us 72 hours to have your information listed on the website. If you are not immediately approved, feedback will be given and a conversation will be started about potential changes and a time frame to resolve them.

Again, thank you so much for your interest in the LGBT Health Coalition and we look forward to working with you!

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