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Survey for PFLAG Members

We Want to Hear From You

PFLAG members receiving gender-affirming care for a patient under the age of 18 at a hospital, please fill out this form to share your story.   

PFLAG Members Survey

Name(Required)
Please share your personal email rather than your work address.
Are you or anyone in your family a member of PFLAG?(Required)
Are you or your family member receiving, or have you or your family member recently received, gender-affirming medical care for a patient under the age of 18?(Required)
How was your care at this location covered or paid for?

What form of gender-affirming care did you receive?
This field is for validation purposes and should be left unchanged.

By providing a telephone number and submitting the form you consent to us contacting you by SMS text message. Message and data rates may apply. You may at any time reply STOP to opt out of further messaging.