TransCEND Trans-Affirming Provider Questionnaire
Thank you for your interest in being listed as a trans-affirming service provider on the TransCEND Canton website. Please complete the following form with information regarding your facility, documentation, experience and education.

We strive to ensure that the providers/services listed on our website are trans-affirming, not just “trans-friendly” or “accepting of all.” We understand that providing a trans-affirming experience from the moment the client finds your name to termination of services can be difficult. If you find that your practice/service is not trans-affirming (yet) feel free to reach out to us! We’re happy to consult with you to create a trans-affirming environment and experience.

If you need assistance regarding this form, please send an email to kevin@transcendcanton.com.
Email address *
Your Name *
Provider Name (if different)
Provider Services (ex. HRT, MTF Gender Affirmation, etc.) *
Location Information *
Please provide full address(es) and phone number(s).
Have you worked with transgender patients?
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