DSI Provider Directory Submission

This is the internal DSI team form to add a provider to the No More Gatekeeping list.

Name(Required)
Please write pronouns such as (she) or (she | they)
Max. file size: 1 GB.
Add a picture if you want, but this is optional
Copy and paste the website link from your browser so the link starts with https:// and then please capitalize every word in the web address for accessibility. Ex: https://VanEthanLevy.com
City & State
Meeting Type
Select all that apply
Select all that apply
Licensure
Provider and/or Therapist = Trainee, Associate, Practicum, Intern, or Unlicensed
Pricing
Select all that apply
Insurance Providers
Languages spoken for assessments
If a language you speak is missing, please email NoMoreGatekeeping@gmail.com so we can add it to the list.
I will write people letters to start hormones and/or have surgery after 1 assessment/session(Required)
I will write a letter for a gender marker and/or name change for IDs, driver's licenses, and passports(Required)
This field is for validation purposes and should be left unchanged.

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