A person who identifies as LGBTQ+ is eligible to fill the LGBTQ Friendly Intake Form.
Date of Birth
How do you identify yourself?
Do you feel comfortable openly expressing your sexual orientation/gender identity?
Have you ever experienced discrimination or violence because of your sexual orientation/gender identity?
Do you feel like you have to hide your sexual orientation/gender identity in order to avoid discrimination or violence?
Do you feel comfortable discussing your LGBTQIA+ identity with others?
Do you feel that you have a strong support system of family and/or friends when it comes to your LGBTQIA+ identity?
Do you feel that your workplace is LGBTQIA+ friendly?
Do you feel that your community is LGBTQIA+ friendly?
How do you feel to be a part of LGBTQ community?