2021 TIES Wellness Center Attendee Registration
The TIES 2021 Wellness Center offers free virtual conversations with trans-friendly healthcare providers in the medical and mental health fields. This is a great opportunity to ask questions, identify resources, and discuss general next steps to getting your healthcare needs met. Providers cannot diagnose you at the Wellness Center.

On Wednesday, all are welcome to the “Ask A Healthcare Provider” Drop-In Hour. Stop by any time for questions relating to medical health or mental health -- questions and conversations during the drop-in hour are NOT confidential and other TIES participants may be present.

Free confidential virtual appointments are available on Thursday, October 21 from 4:30-7:30 pm and Saturday, October 23 from 2:00-5:00 pm.

Please fill out the information below by Tuesday, October 19 at 5:00 pm to reserve your appointment time(s). You will soon receive confirmation of your appointment(s) and instructions for how to access your appointment(s) with the provider(s). All appointments are tentative until confirmed by email. If you have any questions, contact Kyleigh at khynes@equalityvirginia.org, Thalia at thernandez@equalityvirginia.org, or call the Equality Virginia office at 804-643-4816.

Registración del Centro de Bienestar para TIES 2021 (español): bit.ly/TIES2021bienestar 
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Email *
First Name: *
Please use the name you go by, this does NOT need to be your legal name.
Last Name: *
Please use the name you go by, this does NOT need to be your legal name.
Pronouns:
This is optional, but will help us properly address you.
Gender Identity:
This is optional, but will help the provider seeing you to better understand your needs.
What is your race?
This is optional, but can help us schedule clients who identify as a person of color with a healthcare provider of the same race or who is at least also a person of color, if that is something the client would prefer.
If you identify as a person of color, would you prefer to talk with a health care provider who is also a person of color?
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Phone Number: *
Do you have any accessibility concerns you'd like us to know about?
Age on October 20 (the first day of the TIES Wellness Center): *
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