TRANS AND GENDERQUEER HEALTH CARE: YOUR HEALTH, YOUR EXPERIENCES!

MISSION STATEMENT:

The Pacific Northwest Trans and Genderqueer Healthcare Initiative is a local collaboration of trans, genderqueer, and allied community members. The mission of the PNWTG Healthcare Initiative is to raise awareness of barriers to healthcare facing trans and genderqueer people. Through developing and implementing cultural competency trainings based on direct input from trans and genderqueer communities, the PNWTG Healthcare Initiative will provide ongoing educational opportunities for healthcare providers surrounding trans and genderqueer issues and concerns. By providing educational resources to healthcare professionals, the PNWTG Healthcare Initiative will assist in the development of trans and genderqueer-affirming clinical spaces, and the sustained dismantling of longstanding barriers to care.

STATEMENT OF SURVEY INTENT:

We know that people in the trans and gender-variant community are frequently surveyed about their bodies and experiences, and that this can sometimes feel intrusive. This survey is not being conducted in the service of a school project or work assignment. The sole intent of this survey is to collect information about peoples’ needs and experiences in receiving healthcare, so that we can integrate those experiences in how we train healthcare providers to better serve our community. This survey is anonymous and participation is voluntary (you may answer any or all of these questions).

DEMOGRAPHIC QUESTIONS:

(Please select your response. You may select more than one.)

1
Age:
under 18
18-24
25-34
35-44
45-54
55-64
65 + 
2
Race/Ethnicity: 
African-American
Asian/Pacific Islander
Latino/a
Multi-racial
Native American
White
Other, please specify
3
Gender:
Male
Female
Transgender (female to male)
Transgender (male to female)
Transgender (identify as neither male nor female)
Genderqueer
Intersex (identify as male)
Intersex (identify as female)
Intersex (identify as neither male nor female)
Other, please specify
4
Sexual Orientation:
Lesbian
Gay
Bisexual
Queer
Heterosexual
Not sure/Undecided
Other, please specify
5
Yearly Income:
Less than $11,000
$11,001 - $20,000
$20,001 - $60,000
$60,001 - $100,000
more than $100,000
6
Education:
Less than high school
High school/GED
Associate’s degree
College degree
Graduate degree 
Other, please specify
7
Employment Status:
Work full-time
Work part-time
Unemployed
Student
Retired
Disability
Other, please specify
8

Is any part of your income derived from the sex industry? 
9

Do you identify as a person with a disability (physical and/or mental)? 
10

County of Residence (for example: Multnomah, Clackamas):  
11
Housing Status:
Own
Rent
Staying with friends/family
Institution/special facility
Homeless 
12
Health Insurance:
None
State Subsidized
Private (through work or school) 
Other, please specify
13
If you have insurance, are you able to use it for expenses related to physical transition?
Yes
No
Does not apply

SURVEY QUESTIONS:
14

On intake forms, how would you like to be asked about your birth sex and gender?  (Examples: “sex at birth,” “assigned sex,” “gender,” “preferred gender,” “gender identity,” etc.)
15

Do the intake forms at your doctor's office have a place to write a preferred pronoun and preferred name? If so, do the physician, office staff, medical assistants, nurses, etc. use your preferred name and pronoun consistently?
16

Can you think of anything that a clinic/doctor's office could do to promote a welcoming atmosphere for trans and genderqueer people?
17
Does your medical provider use language to refer to your body that you feel comfortable with? Has your doctor ever asked you about which terms/language you would prefer to use when referring to your body?
18
Have you ever had a medical experience which felt particularly trans/genderqueer-positive? If so, what were the key aspects that made the experience a good one?
19

Have you faced discrimination in a health care setting or had any negative experiences with medical professionals that you felt were related to being trans/genderqueer? Please describe.
20
Have you ever been denied medical services, or made uncomfortable for seeking a procedure not typically associated with the gender your provider perceives you as? Please describe.
21
Do you have a primary care physician (a doctor you see regularly, or any time you feel you need medical care)?   
Yes
No
22
If you do not have a primary care physician, is difficulty finding a trans/genderqueer-positive provider part of the reason you do not have one?     
Yes
No
Does not apply (I have a primary care physician)
23
Do you feel safe at your doctor's clinic?    
Yes
No
Does not apply (I don't have access to a clinic)
24
Do you feel your medical provider makes assumptions about your sexuality and/or gender identity that negatively affect your medical care and/or your experience accessing health care?
Yes
No
Does not apply (I don't have a medical provider)
25
Do you feel comfortable asking your provider questions about your medical treatment (i.e. why certain labs are ordered, what options exist for treatment, cost of services, etc)? 
Yes
No
Does not apply (I don't have a medical provider)
26

Name three topics you think would be important to cover in a training on trans and genderqueer healthcare for medical professionals:

27
Do you feel comfortable with the information you provide in this survey being used anonymously for training purposes?           
Yes
No
28
Are you aware of any specific clinics or providers that might benefit from a trans and genderqueer cultural competency training? If so, please list:
Thank you for taking the time to complete this survey! Your answers are much appreciated and your input is invaluable in shaping our trainings for providers.