Needs Assessment Survey

Please take a few minutes to answer this short 25 question survey. The data collected is completely anonymous and nobody will contact you with further questions. The information you provide will be used to guide future funding and programs that help to improve the lives of transgender people.

We need your help!

1. What is your age?

2. What is your zip code?

3. What is your gender identity? (How you identify yourself)

4. What is your birth sex?

5. What is your birth gender?

6. What is your race?

7. What sexual orientation do you consider yourself?

8. Do you know your HIV status?

9. When was your last HIV test?

10. Have you ever exchanged sex for money or drugs?

11. Do you currently have a primary care physician?

12. Do you currently have some form of healthcare insurance coverage?

13. If so, what kind? (If not applicable, mark n/a)

14. Where do you currently go for medical care? (If not applicable, mark n/a)

15. Please rate the quality of care you receive or have received in the past year (5 being excellent, 1 needs improvement)

16. How available has basic medical care been for you?

17. If you are transitioning, plan on transitioning or have transitioned, how available has gender transition-related medical care been for you?

18. Have you ever been discriminated against by a health care provider because of your gender identity or expression?

19. Have you ever been discriminated against when accessing emergency room or EMT/ambulance services because of your gender identity or expression?

20. Have you ever been harassed or treated disrespectfully by administration staff in a health care or social service setting because of your gender identity or expression?

21. Do you think that there are enough health care/primary providers in your area who are competent and knowledgeable about trans health issues?

22. What are the top 3 health issues that you think affect the transgender community?

23. Do you think that there is a need for a dedicated program for training, resources, and referrals for the transgender community?

24. In what areas would you be most interested in seeing specific outreach or programs for the transgender community? Choose three.