Register as a Service Provider | Rainbow Health Ontario

Service or Business Name *

Website *

Example: https://www.rainbowhealthontario.ca/

Public Contact Phone *

Public Contact Email *

If applicable, what is the name of the main service provider or the sole practitioner whom this listing is for? This field can be left blank for a team of service providers such as a family health team or hospital department.

What are the service provider's professional credentials? (MSW, PhD, etc.)

Which email address should we use to contact you about this listing? (Will not appear publicly) *

Service Description and Program Information *

Hours of operation *

Address line 1

Address line 2

City *

Postal Code *

Full Address

Satellite Locations

	Phone Number *	Address *	Full Address
1

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What best describes you or your organization? *

I am a healthcare provider
I specialize in other services

Other Services *

Are you an individual practitioner or part of a team? *

Individual practitioner
Part of a health team

What best describes your health team? *

Community Health Centre
Family Health Team
Hospital Department
Team of Service Providers

What is your professional designation? For a team, select all designations and/or services that are part of your team *

I can provide transition related surgery assessments for top or bottom surgeries

I can provide secondary assessments for transition-related bottom surgeries

I have training and/or experience with the following populations (check all that apply)

I have completed an RHO Training

I have taken the following RHO Trainings

Foundations for all health care providers working with trans, non-binary, and gender non-conforming adult clients (19+)
Foundations for trans-positive counselling
Introduction to LGBT2SQ and health needs
Introduction to LGBT2SQ emotional and mental health
LGBT seniors and health needs
Removing the barriers: making your organization LGBT2SQ-positive
Transition in the workplace
Transition-Related Hormone Therapy in Primary Care (5.0 Mainpro-M1 credits)
Transition-related Surgeries: planning, referral, and care (5.5 Mainpro-M1 credits)

Access to Service *

Appointment Required
Referral From Doctor
Self Referral

I/we provide services in... *

Are your service fees...

Covered by OHIP
Fee for Service
Fee for Service With Sliding Scale
Free

Service Fee

Service Fee Minimum ($/Hour)

Service Fee Maximum ($/Hour)

This service has accessibility features available for users with mobility or other disabilities

Submission Date

Last Renewal Date

Connected User

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