Patient recommendation
This form is for transgender patients to recommend their healthcare provider to be added to our database at https://genderminorities.com/find-transgender-info-services/medical-surgical/ 

If you are a healthcare provider and wish to register your practice, please use this form instead https://docs.google.com/forms/d/e/1FAIpQLScidRGcivu3brbdIt-qQNOILkq5at6L89F1HDpI9VDw9hlRKA/viewform

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1. Name of provider or practice *
2. Provider website
3. Provider phone
4. Provider email
5. In which region is the healthcare provider located? *
Required
6. Category or categories:
7. Is there anything you would like to tell us about your recommendation?
8. Can we publish your comments from question 7? For example, in our reports or funding applications. If you have written anything that would identify yourself or others, we would remove the identifying details.
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