TG Protocol Request Instructions and Request Form.doc - callen-lorde 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the top section of the 'Request for Transgender Health Program Protocols and Acceptance of Terms of Distribution' form. Ensure you provide your name, agency/company, address, telephone number, and email.
3. Carefully read the terms of distribution outlined in the document. Your acceptance is crucial for receiving a copy of the protocol. Don’t forget to sign at the bottom of the form.
4. If applicable, attach a copy of your medical license or a signed statement confirming your authority to request this information.
5. Prepare a check or money order for $10.00 made out to Callen-Lorde Community Health Center and include it with your completed form.
6. Mail all documents to Callen-Lorde Community Health Center at the specified address provided in the instructions.

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