Letter from Healthcare Professionals Supporting Trans Pennsylvanians

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This letter will be distributed to members of the Pennsylvania General Assembly as they consider banning transgender healthcare coverage under CHIP and Medicaid. The contact information and institutional affiliation of signatories will NOT be listed in the letter, but are for our internal use. Please contact us with any questions at info@payouthcongress.org. This letter is supported by the Bradbury-Sullivan LGBT Community Center and the Pennsylvania Youth Congress.

Full Name *

Letters Following Your Name

i.e. MD, DO, LCSW...

Professional Title *

Counselor

Doctor of Osteopathic Medicine (DO)

Medical Doctor (MD)

Nurse

Nurse Practitioner

Psychologist

Psychiatrist

Psychoanalyst

Psychotherapist

Social Worker

Other:

Required

Phone Number *

Email Address *

Institution/Practice Affiliation *

Location in PA *

i.e. Pittsburgh, Scranton...

Are you willing to speak to the media in support of transgender healthcare?

Yes

Not at this time

Confirmation *

I agree to signing the above statement in support of transgender healthcare coverage in CHIP and Medicaid in Pennsylvania. I understand that my name will be included in the letter upon submitting this form.

Required

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This form was created inside of The Pennsylvania Youth Congress.