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Submit your feedback using the brief form below. Please complete and submit the survey only once. You may choose to complete the survey without providing your name and contact information. We do not share website visitor information with third parties. Historical form: online submissions are unavailable in this restored copy. 1. What medical and mental health topics affecting the LGBT community are most important to you? 2. Which of the following topics interest you? Check all that apply. Aging Alternative health care Anal health Body image for women Body image for men Cancers in men Cancers in women Chronic illness Disabled community/ accessibility Domestic violence Depression/anxiety Drugs/alcohol Emotional health Fertility and pregnancy Fitness and nutrition HIV/AIDS Health care access Health care differences for LGBTs Hepatitis Intersex health Men's sexual health Multiple chemical sensitivities Parenting STDs and safer sex for men STDs and safer sex for women Seniors Transgender health Violence and hate crimes Women's health Youth Other 3. What site features are you likely to use? Check all that apply. Condition information Educational videos E-mail newsletter about LGBT health Health conferences and events specific to LGBTs Links to LGBT health resources Message boards for peer interaction about LGBT health and wellness Online support groups Forum for interacting with LGBT-friendly providers Search for LGBT-friendly providers Wellness and prevention education Other 4. How would you rate the site in terms of usability? Choose one. User-friendly Mostly user-friendly but with a few confusing parts Confusing If you found any problems with usability, please describe as specifically as possible: 5. Other comments Optional Fields (for demographic purposes) Which of the following applies to you? Check all that apply. LGBT health care consumer Ally of an LGBT health care consumer LGBT-friendly health care provider Other State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming Gender Age: under 18 18-25 26-39 40-49 50-59 60-69 70+ Contact Information (Optional) Name: E-mail Address: Phone Number: contact me by: email phone Your personal information is kept private and confidential. Healthcommunities.com and lgbthealthchannel do not share visitor information with third parties. See our privacy policy.
Submit your feedback using the brief form below. Please complete and submit the survey only once. You may choose to complete the survey without providing your name and contact information. We do not share website visitor information with third parties.
Historical form: online submissions are unavailable in this restored copy.
1. What medical and mental health topics affecting the LGBT community are most important to you?
3. What site features are you likely to use? Check all that apply.
Condition information Educational videos E-mail newsletter about LGBT health Health conferences and events specific to LGBTs Links to LGBT health resources Message boards for peer interaction about LGBT health and wellness Online support groups Forum for interacting with LGBT-friendly providers Search for LGBT-friendly providers Wellness and prevention education Other
4. How would you rate the site in terms of usability? Choose one.
User-friendly Mostly user-friendly but with a few confusing parts Confusing If you found any problems with usability, please describe as specifically as possible:
5. Other comments
Optional Fields (for demographic purposes)
Which of the following applies to you? Check all that apply.
LGBT health care consumer Ally of an LGBT health care consumer LGBT-friendly health care provider Other
State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming
Gender
Contact Information (Optional)
Your personal information is kept private and confidential. Healthcommunities.com and lgbthealthchannel do not share visitor information with third parties. See our privacy policy.
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