Pride Provider Qualification Questions
A provider that qualifies to be a 'Pride Provider' will be recognized by the Greater Columbus LGBTQ Health Coalition as a key healthcare provider to the LGBTQ community and will have their services promoted to this community via the coalition. Pride Providers will receive an official decal to display in their offices. This decal will serve as recognition of their services. Each individual provider must answer "yes" to these qualification questions in order to be recognized as a Pride Provider (ie 1 provider = 1 decal). A decal denotes recognition of an individual provider, not an entire practice. Each provider in a practice may apply to be recognized as a Pride Provider.
Information on qualified providers will be included in a document both in hard copy format and online to be shared with potential clients.
Do you promote your services to the LGBTQ community in advertising, web presence, or word of mouth? *
Explain:
Have you provided or received any LGBTQ-specific competency training? *
Where or by whom? Also, if you have not had training, but would like to be trained, please indicate that as well.
Do you have brochures, photographs, advertisements, or other print materials specifically designed to educate or support LGBTQ clients and their families directly visible and/or available to them? *
Explain:
Does your paperwork include sexual orientation and gender identity inclusive language? *
If not, do you provide your patient/client population an opportunity to self-identify sexual orientation and gender-identity in any way (verbally, writing in correct pronouns, in the notes field, etc.)? *
Your Title and Name *
What organization/practice is your primary place of work? *
Address: Where you would like your official Pride Provider sticker and accompanying documentation to be sent? *
Address of establishment or business to be shared with clients: *
Phone Number *
Email Address *
Organization/Practice Website