The Student Health Center wants to affirm all gender identities of their clients. Please complete the following Name and Pronoun Form if you identify as non-binary, transgender, or gender diverse. This will allow us to use the name and pronouns that affirm your personal gender identity.

Please note that the chosen name will appear in parentheses after legal first name on all mailings and documents from the Student Health Center. If you are not comfortable with this, please do not complete this form, and speak to your provider about how we can best address your needs.