If you have received a consultation for gynecological concerns and you would like to recommend your practioner, fill out the questionnaire below!  This form is anonymous and it will not be shared.  It will only take 4-5 minutes of your time to complete the form.

Please note:

  • If you want to submit the names of multiple practitioners, you must submit a questionnaire for each of them.
  • No practitioner is perfect. Even if they don't meet all the criteria, send us the completed questionnaire anyway.
  • If you are a practitioner (general medicine or gynecology) we ask that you please don't submit yourself.  This project is made FOR and BY our users.
  • All questions marked with an asterisk (*) are required.

Remember, this is an evolving, collaborative project which depends on all of you!  We are counting on you to add to it, complete it and keep it up to date via comments or e-mails (your communications will be considered but will not be published).

And don't hesitate to e-mail us at gynecopositive@gmail.com! We want to hear any questions you have about practitioners, your personal requests, or if you want to get involved.

P.S. Any practitioner who does not want their name to appear on our site should let us know by e-mail: gynecopositive@gmail.com.  The information will be removed.

1. Preliminary question *
Have you ever experienced problems with a healthcare professional and/or in accessing care?
(for example, as a woman, lesbian, bi, gay, trans, person of color, drug-user, non-francophone, HIV positive, person with a high BMI, person with a disability, undocumented migrant, sex worker, etc.)
First name, last name *
Is the consulting office accessible to people with disabilities?
3. Interpersonal aspects
How would you rate your practitioner's listening and discussion skills
If you are lesbian, trans, HIV positive, a drug user, etc. Have you informed this practitioner?
Are they respectful of your sexuality?
Have you felt safe and comfortable speaking about issues regarding your body, your practices, your emotional and sexual life and—possibly—about sexual abuse, unwanted sex, etc.?
Has your practitioner ever made moralizing remarks regarding your sexual practices, procreation, etc.?
4. Care and support
Does your healthcare professional leaves you free to make choice and negotiate? (reaction to refusal)
Have they let you choose what type of contraception to use, if any?
Do they offer intrauterine device (IUD) insertion?
Was this offer without conditions ? (many gynecologists refuse to insert IUD for women without children and/or who have multiple partners)
Has your practioner responded in a satisfactory manner to your request for volunteer sterilization? (tubal ligation, vasectomy, etc.)
If so , please specify
Have they provided a satisfactory response to your request for abortion? (choice of the abortion method, advice, support, procedures, contacts, etc.)
Have you felt comfortable expressing your desire to have children with and seeking advice from your practioner?
If so, how?
Has your practitioner satisfactorily taken charge of pre-natal checkups and pregnancy follow-up exams?
Have you felt comfortable talking about your transition (trans) and seeking advice?
If yes/no, why?
Has your healthcare professional ever talked with you about STIs (sexually transmitted infections)?
If so, specify
Do they prescribe hormones (trans, HRT, other)?
If yes, specify
Have they provided satisfactory responses to your other requests (endometriosis, endocrinological problems, etc.)?
Which one?
Have they allowed you to accept or refuse gynecological examinations (breast examination, pelvic examination, smear test, etc.)?
Did they explain what they were doing either before or during the exam?
Did you feel rushed or mistreated during the physical examination (rushed vaginal touch, IUD insertion, etc.)?
No medical examination requires total nudity. Were you asked to be completely naked ?
Did they pay attention to your possible reluctance to being naked?
Have they ever offered you self-examination (smear test, vaginal swab, etc.)?
Have they ever offered to let you lay in the left lateral position during a gynecological examination?
Would you particularly recommend this practitioner to certain people or groups of people? Who ? Why ?
Are there any issues that were not discussed in this questionnaire, which you think should have been included?