Gender Affirming Provider Review
Access to gender-affirming healthcare can play a critical role in the overall well-being of any trans/non-binary individual. With our provider database, we continue our search for inclusive providers who provide excellent gender-affirming healthcare to the trans community. While these providers have stated that they can provide such care, we would love to hear from you about your experiences with one of the providers we have listed on our database! We want to ensure that our community is receiving the healthcare they need in order to thrive.

All questions about your experience with this provider and at this practice are optional. If you would like to add more nuance to your response, feel free to leave a comment using the "other" option. There will also be a space at the end of this form where you can leave any other comments you may have! 
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What is the name of the provider who you are leaving a review for? *
What practice does this provider work at? *
Interactions with Provider
The following questions will ask about your experiences with this provider. 
Did this provider ask for/confirm your pronouns and preferred name?
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Did this provider consistently and correctly use your pronouns and preferred name?
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Did this provider seem knowledgeable about gender-affirming/trans-specific healthcare needs? 
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Did this provider offer to discuss gender-affirming surgeries and/or hormone therapy with you? 
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Did this provider ensure that they were acting in a way that avoids triggering feelings of gender dysphoria? (eg. asking about what parts of your current anatomy you were comfortable discussing or explicitly asking what steps they could take to avoid it.)
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Was this provider knowledgeable about the unique barriers faced by the trans/non-binary community? 
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Did this provider ask questions about your emotional wellbeing and/or discuss mental health services with you?
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Was this provider knowledgeable about other intersecting aspects of your identity and how they affect your healthcare? (eg. race, ethnicity, disability, sexual orientation, etc.)
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Did you feel comfortable discussing your healthcare needs with this provider?
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Interactions with Office and Other Staff
The following questions will ask about any interactions you had with the staff at this practice and about the practice facility itself. 
Did the office staff consistently and correctly use your pronouns and preferred name?
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Did you feel welcomed and understood by the staff at this practice?
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Were there gender-neutral facilities (eg. bathrooms) at this practice?
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Were there any visual statements of LGBTQ+ support in the office? (eg. pride flags, stickers, posters, or written statements.)
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Overall Experience
The following questions will ask you to rate your experience with this provider and allow you to leave any additional feedback you may have. 
Overall, how would you rate your experience with this provider?
I did not feel welcome or comfortable with this provider
I felt extremely comfortable discussing my healthcare with this provider
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If there is something that you think is important for us to know about your interaction with this provider (good or bad), please feel free to add any additional comments in the box below. 
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This form was created inside of TACT.