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1-to-1 Peer Support Interest Form

Hello there! Thank you for your interest in LGBTQ Wellness' short-term 1-to-1 Peer Support services for folks for 2SLGBTQIA+ (Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, Agender/Asexual/Aromantic, +). Please fill out this form to connect with our staff to set up a consultation session.

The full guidelines for 1-to-1 peer support will be detailed at the bottom of this form, but here is brief overview of our scope of services:
  • LGBTQ Wellness can provide up to 6 sessions of 1-to-1 peer support per person. Each session can be up to 1 hour.
  • LGBTQ Wellness will reach out to the community member to have a consultation (20-30 minutes) before the 6 sessions begin.
  • The 6th and final session of 1-to-1 peer support will consist of identifying next steps and warm hand-offs if desired.
Take care!
1.Name
2.Pronouns
3.Email(Required.)
4.What is your gender identity(s)? If you are exploring your gender and/or do not have a label, feel free to put "I don't know" or "N/A".(Required.)
5.What is your sexual orientation? If you are exploring your sexual orientation and/or do not have a label, feel free to put "I don't know" or "N/A".(Required.)
6.Age(Required.)
7.How did you find out about LGBTQ Wellness?(Required.)
8.What led you to exploring short term peer support?
9.Please read and agree to the terms and conditions of our short-term 1-to-1 peer support below:
  • LGBTQ Wellness can provide up to 6 sessions of 1-to-1 peer support per person.
    • Sessions will be between one community member and one LGBTQ Wellness staff member.
    • Each session will have a maximum duration of 1 hour.
    • Sessions will be spaced out based on the community member’s needs, but there will be a maximum of 2 sessions in one month spaced two weeks apart.
  • LGBTQ Wellness will reach out to the community member to have a consultation (20-30 minutes) before the 6 sessions begin. The consultation can be done through email, phone, or Zoom to go over the following:
    • Mandatory reporting
    • Scope of services
    • Goals for support
    • Possible additional resources
  • The sixth and last session of 1-to-1 peer support will consist of identifying next steps and warm hand-offs if desired. LGBTQ Wellness can provide the following during this session:
    • Referrals to community resources including additional peer support services
    • Referrals to clinician
(Required.)