Intake form: Florida Board of Medicine Rule Impacting Gender Affirming Care

On Friday, August 5, 2022, the Florida Board of Medicine ignored the warnings of medical experts and parents with transgender or non-binary children and began the process of changing the “standard of care” to prevent gender-affirming care for trans and non-binary youth — a move that would put the licenses of medical professionals at risk for providing life-saving care. The Board is now working to impose this new "standard of care" on all trans and non-binary youth in Florida.

Will your child be impacted by the Florida Board of Medicine's new rule regarding gender affirming care? We want to hear from you.

Are you the parent of a child who will be impacted by the Florida Board of Medicine's planned rule regarding gender affirming care? We want to hear from you. If you are a minor who will be impacted by this rule, please ask a parent or guardian to fill out this form.

* indicates required field

Your Information

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Pronouns

Child First Name

Child Last Name

Child Pronouns

Child Age

Parent/Guardian County of Residence

Parent/Guardian Address

Phone

Best times to contact you?

Morning

Afternoon

Evening

Legal intake

Is your child currently receiving gender-affirming medical care? If yes, please describe the type of care you are receiving

How long have they been receiving the care identified above?

Do you plan to seek gender-affirming care for your child in the future?

Type of health insurance:

Private insurance

Medicaid

Other

Has your child experienced changes to their course of medical care or concerned communications from providers as a result of Florida’s recently proposed changes to standards of gender-affirming care?

Yes

Additional comments

Have you always lived in Florida? Please describe whether you have received care only in Florida, in another state, or in multiple states including Florida.

Disclaimer and Notice

This Survey does not give legal advice, and you should not rely on it as legal advice. You should not rely on the information you get from this site and should speak with a lawyer to get advice on your specific situation. We also cannot promise that the information on this site is complete, accurate, or up-to-date.

This Survey is not a solicitation or an offer by the American Civil Liberties Union and its affiliates to represent you. We cannot promise you that the information you provide will lead to any specific action on the American Civil Liberties Union or its affiliates part. Once you complete the survey, the American Civil Liberties Union of Alaska may not do anything—including contact you—about your situation.

If you fill out this Survey, you agree that the American Civil Liberties Union, the national ACLU or its affiliates, if identified as part of the Survey, or one of its coalition partners may use the information you give us, as long as we don’t include your name, address, email or phone number, for one or more of the following purposes: (1) legislative testimony, (2) litigation; (3) contacting a city, state or federal agency; or (4) telling your story to the public, including the media. If the American Civil Liberties Union, the national ACLU or its affiliates, or one of its coalition partners wants to identify you, we will contact you prior to doing so.

We will keep your name, address, telephone number and email confidential unless you give us permission to use it or unless we are ordered to turn it over by a court (although we will attempt to prevent any disclosure).

Leave this field blank