Provider Application Form

If you are a licensed, sex positive and all gender and lifestyle affirming clinician, physical or mental health provider, or wellness provider, and your practice is in New York City, please fill out the form below to be considered for a listing on Please note that listing priority is given to those who know personally and are referred by an existing provider, and who have multiple personal connections to the communities we serve. Also please be aware that because I maintain this website myself as a labor of love, I sometimes have to put listing additions on the back burner due to other obligations, meaning that the timing for new listings can vary widely from a day to several weeks or longer.

  • Accepted file types: jpg, gif, png, pdf, jpeg.
  • Please note that they will be contacted to verify your connection, and listing priority is given to those who are referred by someone already on the site.
  • This field is for validation purposes and should be left unchanged.