1Personal Information
2Practice Information
3Inclusion Criteria

Welcome! Tell us more about you and your practice/organization.

This should take 10-30 minutes to complete. You can expect questions about your practice, your experience with patients from the LGBTQ community, and any special training you have received.

This will not be public, but will be used for logging in and updating your profile.
This password will be used for logging in and updating your profile should you be accepted to the directory.
This will not be public — we will use it to confirm your account and communicate with you.

Let's learn more about you.

This information will be listed in your public directory profile.
For example: "Hello, I'm [name]. I have been practicing for [number] years and I focus on treating [conditions]. I am passionate about..."
Note: We share this information for people of color who may prefer to see healthcare providers who share their ethnic background. It also helps us evaluate our efforts to include providers from diverse and potentially marginalized communities.
What services do you provide? Please check all that apply.
Click or drag a file to this area to upload.