Health Provider Survey
Autistic Women & Nonbinary Network is collecting information ongoing in order to keep our resource list current which details gynecologists (or other intimate care providers) who offer accessible and sensory-considerate health care.

The survey is anonymous and designed for anyone who needs to use a gynecologist or similar health care provider. We also included text boxes for all participants to provide additional comments if needed. Thank you for participating!
1. How do you identify? *
2. What is your age? *
3. Where do you live?
Please include: city, province, state, country
4. Do you currently have a gynecologist (or other intimate care provider)?
Clear selection
If yes, is your gynecologist (or other intimate care provider) a man or woman?
If no, please explain
5. Please share all sensory sensitivities that you want a gynecologist (or other intimate care provider) and their office staff to accommodate:
(i.e.: bright lights, odors, noise, communication, etc.)
6. Does your gynecologist (or other intimate care provider’s) office accommodate your specific needs?
Please include physical and/or sensory needs (i.e.: dim lights, comfortable temperatures, augmentative communication device, physical limitations, etc.)
7. Would you recommend your gynecologist (or other intimate care provider) based upon your personal experience?
Clear selection
Additional Comments:
8. Does your gynecologist (or other intimate care provider) ask questions in a manner which you feel comfortable?
Please include whether or not they answer your questions and communicate with you in a way that you feel respected and understood.
9. Does your gynecologist (or other intimate care provider) respect your wishes regarding birth control and reproductive health?
Please include any experiences with forced sterilization or if sterilization was recommended.
10. Does your gynecologist (or other intimate care provider) inquire about your safety with respect to domestic violence, abuse, or sexual abuse, etc.?
Clear selection
Additional Comments:
11. Contact information for your gynecologist (or other intimate care provider)
Please include: city, province, state, country and telephone number
12. Is there anything else you would like to share?
Submit
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