P.O. Box 6333
Richmond, Virginia 23230
October 1, 2005
Dear Healthcare Professional:
Rainbow Passport is a free public wellness service, offering gay, lesbian,
bisexual, transgendered (GLBT) persons information and referrals to supportive:
healthcare professionals, faith communities, support , recreational and social
groups.
We will insert a notice to run every Thursday in the Richmond Times Dispatch
“Healthnotes” column. This notice will provide an email link to
Rainbow Passport for individuals to request a list of groups and professionals
who are GLBT friendly.
Many times GLBT persons feel they have no place to turn when they are in need of healthcare and support. The resulting lack of support and connection results in untreated illness, a greater socioeconomic burden on individuals and society, and needless pain and isolation.
We seek your permission to include you on this list of healthcare providers and professionals who care.
Please indicate your preference on the attached form below and return it to us. We will not include you on the list unless we have your express written consent..
Thank you for your consideration. We are including a self-addressed, stamped envelope for your response. We look forward to hearing from you.
Stephanie Myers , Project Organizer
-----------------PREFERENCE FOR RAINBOW PASSPORT HEALTHCARE PROVIDER LIST-------------------------
Your Name_________________________________________________
(___)YES, please include me on the Rainbow Passport list of GLBT friendly and sensitive healthcare providers in Virginia. Which populations are you able to best serve?
(___) Gay Men (___) Lesbians (___) Transgender (___) Bisexual (___) All GLBT
persons
Do you specialize in certain issues? _________________________________________________________
(___) NO, please do not include me on the Rainbow Passport list of GLBT friendly and sensitive healthcare providers in Virginia.
(___) Please send me a copy of the completed list of GLBT friendly and sensitive healthcare providers in Virginia.
Do you think any of your colleagues may be interested in participating in our
program?
We will contact them and verify their interest. We do not disclose our referral
source._____________________________________________________________________
Your Signature_____________________________________________ Date_____________
Please indicate your preferred listing.
(Attach card or use additional space on reverse.)
Name__________________________________
Address________________________________
Phone__________________________________
Return to: Stephanie Myers
Rainbow Passport
P.O. Box 6333
Richmond, VA 23230