DocLIST Recommendation
Lesbian bisexual and same-sex attracted women in Australia can recommend a doctor, dentist or mental health professional using this form. Please note that information entered will be kept confidential and only used by the DocLIST team to improve the DocLIST resource. DocLIST is a project of the Australian Lesbian Medical Association. We first ask for your email address as in some cases we wish to contact you by email to clarify something about your recommendation.
Sign in to Google to save your progress. Learn more
Email *
What is the name of the health professional you are recommending? Please note that DocLIST currently lists doctors, dentists and mental health professionals such as psychologists *
What type of health professional are they?
Clear selection
What state or territory of Australia does the health professional work in? *
What is the name of the clinic / health service that the health professional works at? (if known)
What is the address of the clinic / health service that the health professional works at?
What is the phone number of the clinic / health service? (please include area code if it is a landline number)
What is the email address of the clinic / health professional (if known) - optional
Have you seen this health professional as a patient / client / consumer? DocLIST accepts recommendations from women who have seen the health professional regarding their own health. *
Why are you recommending this health professional for DocLIST? *
Do you recommend any OTHER health professionals at the SAME clinic / service as LGB-friendly, whom you have also seen as a patient/client? If so please list their names.
What is your first name? This will remain confidential and will not be disclosed to the health professional you are recommending. *
Do you identify as a lesbian, bisexual, same-sex attracted or queer woman? We ask this because DocLIST is a list of doctors and mental health professionals recommended by this group of women. *
Please provide an email address, phone number or both in case the DocLIST team needs to contact you for further information about your recommendation. *
Thank you so much for taking the time to make a recommendation for DocLIST. Please be aware that it can take some time for us to get in touch with health professionals who are recommended for DocLIST, and that some health professionals who are recommended for DocLIST ask us not to list them on our website (for a range of reasons). This online form is a new way for women to make recommendations for DocLIST. Please share any ideas you have for how we could further improve this form or the process for making recommendations.
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy