Your Voice Matters
Please fill out the information below.
Niagara Pride and Niagara Falls Memorial Medical Center are partnering to improve access to inclusive, compassionate, and equitable healthcare for the LGBTQIA+ community in Niagara County. We want to hear directly from you. Your feedback will help us better understand the healthcare needs, barriers, and priorities of our community so we can develop services that are welcoming, accessible, and responsive. This survey is voluntary and anonymous. Thank you for taking a few minutes to share your thoughts.
What age group do you belong to?
*
Under 18
18–24
25–34
35–44
45–54
55–64
65+
Which healthcare services have you used within the past 12 months?
Primary Care
Annual Wellness Exam
STI Testing/Treatment
HIV Testing
PrEP or PEP Services
Behavioral Health/Counseling
Women’s Health Services
Men’s Health Services
Gender-affirming care
Hormone therapy
Surgical consultation or referral
Substance Use Services
Vaccinations
Nutrition Services
Chronic Disease Management (Diabetes, High Blood Pressure, etc.)
Other
Which healthcare services are most important to you?
Primary Care
Preventive Screenings
Mental Health Services
STI/HIV Testing
PrEP/PEP Services
Women’s Health
Men’s Health
Gender-affirming care
Hormone therapy referrals
Surgical referrals
Care Navigation
Mobile Healthcare
Telehealth Visits
Substance Use Services
Nutrition Services
Other
Have you ever delayed or avoided seeking healthcare?
Yes
No
Why? (Select all that apply.)
Cost
No Insurance
Transportation
Difficulty Getting Appointments
Previous Negative Healthcare Experience
Fear of Discrimination
Did Not Feel Safe or Welcome
Unsure Where to Go
Concern About Confidentiality
Other
What are the greatest unmet healthcare needs for the LGBTQIA+ community in Niagara County?
What would help you feel more comfortable accessing healthcare?
LGBTQIA+ affirming providers and staff
Privacy and confidentiality
Flexible scheduling
Evening or weekend appointments
Mobile healthcare services
Telehealth options
Transportation assistance
Assistance navigating healthcare resources
More education about available services
Other
What days would be most convenient for you to receive care?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What time of day works best for you?
Morning (8:00 a.m.–Noon)
Afternoon (Noon–4:00 p.m.)
Evening (4:00 p.m.–8:00 p.m.)
Where would you prefer to receive services?
Niagara Pride
Mobile Health Unit
Niagara Falls Memorial Medical Center
Telehealth
Community Events
No Preference
Other
Please rate how important each of the following is when choosing a healthcare provider.
*
Rows
Very Important
Important
Neutral
Not Important
Being treated with dignity and respect
LGBTQIA+ knowledgeable providers
Inclusive and welcoming environment
Privacy and confidentiality
Convenient appointment times
Affordable healthcare
Easy scheduling
Are there healthcare services you would like Niagara Pride and Niagara Falls Memorial Medical Center to offer that are currently unavailable?
What health education topics would you be interested in?
Sexual Health
HIV Prevention
Mental Health & Wellness
Nutrition
Chronic Disease Prevention
Gender-affirming Care
Healthy Aging
Tobacco/Vaping Cessation
Substance Use Recovery
Other
Is there anything else you would like us to know?
Would you be interested in helping shape future LGBTQIA+ health programs and services?
*
Yes, I would like to participate in future focus groups or community advisory meetings.
Maybe. Please keep me informed.
No, not at this time.
Optional Contact Information
Full Name
First Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
Should be Empty: