Montana Gay Men's Task Force

GAY-FRIENDLY MEDICAL PROVIDER SURVEY
FDH & Associates is putting together a list of gay and gay-friendly medical and health providers who practice in Montana. We'll put together a list of providers whom we will mail a questionnaire that will ask if they want to be put on the list of providers. This questionnaire will not identify you as the person who identified them. It will simply state that they have been identified as a care provider who has provided healthcare services to gay and lesbian people in Montana.

This list will allow gay/bisexual men in Montana to have access to healthcare providers who are gay-friendly/knowledgeable but it will also allow us to financially support those providers who are gay-friendly. The survey will also include attitudes toward gay men and whether they want information on how to provide better healthcare services to gay men.

Please complete this survey only with providers whom you would recommend to other gay/bisexual men, based on quality of care, their professionalism and expertise.

Who is your primary care provider?
Name

City

Physician/DO — Specialty:
Nurse Practitioner
Physician Assistant
Naturopathic Physician

How "out" are you to your primary care provider?
Completely
Not at all
Don't know

Who is your dentist?
Name

City

How "out" are you to your dentist?
Completely
Not at all
Don't know

Who is your therapist/counselor/
clinical social worker/psychiatrist?
Name

City

How "out" are you to your therapist?
Completely
Not at all
Don't know

Who is your chiropractor?
Name

City

Who is your optometrist?
Name

City

Who is your pharmacist?
Name

City

Who is your massage therapist?
Name

City

Who is your physical therapist?
Name

City

Other?
Name

City

Questions about your healthcare:
1 - Poor 2- Good 3- Excellent

How would you rate your primary healthcare provider?

How would you rate medical facilities where you live?

How would you rate your access to healthcare in Montana?

Are you currently covered by healthcare insurance?
Yes
No

If yes, do you receive healthcare coverage through your partner's insurance?
Yes
No

Have you ever been the victim of discrimination in a healthcare setting due to your sexual orientation?
Yes
No

Have you ever been discriminated in a healthcare setting due to your HIV status?
Yes
No

Would you be more likely to switch healthcare providers if you knew he/she was more gay-friendly than your current provider?
Yes
No

If a gay-friendly healthcare provider were not identified in your area, would you travel to another Montana town to visit one who was?
Yes
No

If you're not "out" to your current healthcare provider, do you fear coming out will cause you to receive sub-standard care or discrimination?
Yes
No

Do you have a power of attorney agreement to allow somebody else to make healthcare decisions on your behalf if you become unable to do so?
Yes
No

Other comments:

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This site is made possible through funding provided by the Montana Department of Public Health and Human Services (DPHHS), HIV/STD Prevention Section.