CONTACT

*All submissions are held in confidence

Parent/Caregiver Support

Please fill out the following form to help us understand your situation.

If you do not hear back within 48 hours:

Resubmit and do not forget your email address so we may assist you.

First Name

Last Name

Email Address (Additional Resources/Help)

Natal sex of your child/relative

Female

Male

Age of Child/Teen/Young Adult

How long has your child/relative been identifying as gender non conforming?

1-3 years

3-5 years

5-10 years

Does your child/relative have co-existing traumas or mental health conditions, such as depression, anxiety, family troubles, autism, or developmental disabilities prior to identifying as transgender, non binary or other label? Please explain here:

City/State

Today's Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

Crisis Connection:

Share Your Story Confidentially

Concerned Physician? Contact us