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Healthcare Provider Competency

Medical and Mental Health Provider Survey

Please take 5 – 10 minutes to complete this short survey about cultural competence in LGBTQ* health care. National research points toward the need for greater understanding and cultural competency in LGBTQ health care, which has been reinforced in local research. Part of our Community Health Improvement Plan (CHIP) -- led by Public Health Dayton & Montgomery County and Montgomery County Alcohol Drug Addiction and Mental Health Services -- is to gauge our local medical and mental health providers’ cultural competence in caring for LGBTQ individuals and to determine who would like to receive more training on this subject.

In 2018, Public Health established an LGBTQ Health Initiative that includes a Community Health Alliance of approximately 60 LGBTQ and ally individuals and companies. One of the Health Alliance action teams is working to assess and enhance cultural competence. Medical and mental health professionals are involved in this effort to foster the best healthcare services possible delivered in a culturally competent and affirming way.

We hope you will assist us in our efforts to help ensure that Montgomery County and the Miami Valley are healthy, safe, and thriving communities for everyone – including LGBTQ individuals. When the survey is complete we will share global general results with you. Our goal is to produce an easy-to-use resource so that LGBTQ residents can more easily locate providers who can meet their needs.

Thank you for your time and attention

Please contact Jerry Mallicoat, LGBTQ Health Initiatives Manager at Public Health Dayton & Montgomery County, 937-224-3727 or

Public Health Cultural Competence Team
Aaron Block, MD, MPH               Robert L. Brandt Jr., MD               Kara Brown

Coyote Capasso, RN, BSN         Devin Dame                                        Michael Ann Glotfelter, PsyD, USAF
Anne Proulx, DO                         Adrian Taylor                                      Jerry Mallicoat (facilitator)
Brendan Wynn

*LGBTQ = Lesbian, Gay, Bisexual, Transgender and Queer. In this survey, we define an “LGBTQ” individual as someone who is lesbian, gay, bisexual, transgender, queer or anyone who identifies in ways other than the typical societal labels related to sexual orientation, gender identity, gender expression, or biological sex.
1. Please provide the name, address and phone number of your practice location. *This question is required.
3. How knowledgeable are you about specific LGBTQ health issues? *This question is required.
1 (Not at all)2345 (Completely)
4. How comfortable do you feel taking care of clients/patients who identify as gay, lesbian or bisexual? *This question is required.
1 (Not at all)2345 (Completely)
5. How comfortable do you feel taking care of clients/patients who identify as transgender or gender non-conforming? *This question is required.
1 (Not at all)2345 (Completely)
6. When client/patient data is captured in your healthcare setting, are there specific questions asking about: *This question is required.
Space Cell YesNo
Preferred name?
Client/Patient gender?
Gender assigned at birth?
Sexual orientation?
If yes, are you using the information for client/patient care and/or payment?
7. Are there any brochures or posters in public areas of your healthcare setting that relate to specific LGBTQ health issues? *This question is required.
8. Has your workplace ever offered any LGBTQ competency training for: *This question is required.
Space Cell YesNo
Healthcare providers?
9. Have you ever received LGBTQ education in a formal setting? *This question is required.
10. If offered, would you be interested in continuing education units (CEUs) and/or continuing medical education (CME) to better address, manage, and treat LGBTQ clients/patients?
This question requires a valid email address.
Which category below includes your age?
What is your race?
(Select all that apply)
What is your gender?
What is your sexual orientation?