LGBTQ Health Resource List Provider Sign-Up

LGBTQ Health Resource List Commitment Form
You will be contacted by email or phone to verify the information submitted below and to gather any further information before it is published.

We encourage all providers to remain updated on current standards and practices for serving LGBTQ patients.  If unsure where to start we recommend the National LGBT Health Education CenterWorld Professional Association for Transgender Health, and The Center of Excellence for Transgender Health.

Completion of the form below is considered a digital signature for the purposes of agreement to the following

Provider Commitment Letter:

By signing below, I agree that I am personally and professionally committed to providing comprehensive, affirming services to members of the lesbian, gay, bisexual, transgender, and queer communities, free from discrimination on the basis of perceived or actual gender identity, gender expression, and/or sexual orientation. I will ensure a safe, comfortable, and respectful environment. I will strive to educate myself about the health needs of the LGBTQ community.