Request In Person Advocacy
After you fill out this form an advocate will contact you within 24 hours to discuss your needs. *If you are in an emergency situation please call 911 and if you need an advocate to meet you at the hospital call or text: 502-694-2227 and we will do our absolute best to accommodate*
If you need financial assistance fill out this form:
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What Pronouns Do You Use? (If you prefer to just be addressed by your name, just write that in this blank)
Preferred Way of Contact
Race (check all that apply
Type of Appointment (Transition Related, Surgery, Primary Care, Etc.)
Date of Appointment
Time of Appointment
Anything You Are Particularly Concerned About/Think We Should Know? (This is where you can request an advocate that shares a certain identity with you (trans, fat, PoC, non-male, etc.) if you wish. Here you can also include what language you speak, if it's not english.
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