NGAHP LGBTQ+ Friendly Provider List
The Nevada Gender Affirming Healthcare Project (NGAHP) is compiling a list of the LGBTQ+ friendly healthcare providers (primary care physicians, surgeons, reproductive care, gynecological care, endocrinologists, therapists, dentists, physician assistants, nurse practitioners, etc.) in the state of Nevada. This list will be hosted on the NGAHP website. Please fill this out and share it with your fellow providers!

This list is for LGBTQ+ providers and ally providers to let the community know you exist in Nevada and how to get safe and affirming healthcare. 

(Contact Axenya Kachen with questions: zeny.kachen@gmail.com)
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Name *
First and last name.
Title *
Job name, degree(s), credentials.
Email
Your email for NGAHP communications (this will not be shared with patients on the website unless you indicate that it should be).
Contact Information
How can patients contact you (e.g. website, phone number of your clinic, email address for patients, etc.)
What kind of healthcare do you provide?
Please state all of the healthcare you provide.
Insurance and financial info for patients
Do you take insurance? Do you offer a sliding scale for patients who do not have insurance? Please state financial info for patients here if this applies to you.
Any personal information about yourself or your office that you want to share
If you are LGBTQ+ yourself and want to share, please do so! :-) Please state what your office does to accommodate LGBTQ+ patients (e.g. asks for pronouns, LGBTQ+ friendly staff, etc.). Lastly, please share any additional information you want listed on the website about yourself, your practice, and anything not included above.
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