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LGBTQIA+ Patient Navigator Form

We can help you find a primary care provider (PCP), specialty care or mental and behavioral health provider, or help you connect with a support group. In addition to in-person visits, our providers are available for virtual visits with patients that are physically located in Michigan to receive care.

1. First Name *This question is required.

2. Last Name *This question is required.

3. Preferred Pronouns

4. Email *This question is required. This question requires a valid email address.

5. Phone Number (optional)

6. Preferred Contact Method *This question is required.

7. What county are you in? *This question is required.

8. Are you seeking Adult or Pediatric services? *This question is required.

9. Services you are looking for *This question is required.

Primary Care Provider
Behavioral Health Provider
Specialty Care Provider
Connection with Community Resources/Support Groups
Other - Write In Please enter an 'other' value for this selection.

10. What kind of community resources or support groups are you looking for? *This question is required.

10. Do you have a preference for gender identity of your provider? *This question is required.

10. Do you want virtual care or in person care? *This question is required.

10. Are there specific treatments you are looking for in primary care? *This question is required.

10. Are there specific modalities that you wish for them to be trained in? *This question is required.

10. What type of specialist are you looking for? *This question is required.

10. Is there a specific service you would like from your specialist? *This question is required.

10. How did you hear about us?

11. Is there anything else you would like us to know?

We’re honored for all Corewell Health West Michigan Hospitals to be recognized as “High Performers” by the Human Rights Campaign’s 2024 Healthcare Equality Index. This designation is awarded based on policies and practices related to equity and inclusion for patients, families and employees.