JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Trans Community Provider Reviews
These reviews help us create more accurate resource guides and provide better recommendations to trans Kentuckians accessing care
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Provider Name
*
Your answer
Age range they provide services for
*
Children/Young Adolescents (Under 13)
Teens (13-18)
Adults (18+)
Other:
Required
Organization/Practice Name
Your answer
Provider Location
*
Your answer
Services (check all that apply, for other please specify, OB-GYN, Neurologist, Etc)
*
Will Write Letters for HRT and/or Gender Affirming Surgery
Therapy
Psychiatry/Med Management
Hormone Replacement Therapy
Hormone Blockers
Gender Affirming Surgery (if you mark this please include which in the box at the bottom!)
Primary Care
Laser Hair Removal
Electrolysis
Other:
Required
Would you recommend them?
*
Yes
No
Unsure
Is there anything you would like to share about your experience with this provider? If you marked HRT above please include if they require a therapist letter or do informed consent.
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Kentucky Health Justice Network.
Report Abuse
Forms
