Trans & Gender Affirming Care ECHO Pre-Survey

Thanks for your interest in the Trans & Gender Affirming Care ECHO. To register, please complete the following pre-survey.

This survey should take no more than 10 minutes of your time. Your responses help us provide information to our stakeholders and delegates about the work we do and advocate to continue providing these services. It also helps us understand who you are and how we can best support you and steward the security of our ECHO space. Thanks for your understanding.

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* 1. Please provide demographic information:

First Name *

Last Name

Organization/ Clinic (please don't use acronyms)

Email Address *

Phone Number *

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* 2. Please list any other names that might appear in your Zoom name. (For security, we check Zoom attendants against active registrants before admitting folks to the Zoom room.)

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* 3. What is your clinical role?

Pharmacist

Behavioral Health

Healthcare Student or Trainee

Other

Other (please specify)

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* 4. The Trans & Gender-Affirming Care ECHO has two tracks. Which track(s) are you interested in?

Pediatric-Focused (2nd Mondays; 2 PM ET)

Adult-Focused (4th Mondays; 2 PM ET)