LGBT Vets Not Using the VA
Case Study

We are doing a nation wide study on why LGBT vets shy away from the VA hospitals or hide their lifestyle from the VA. This study is being done in collaboration with a possible news article and also to help us find ways to relay to the VA what makes you uncomfortable.

The stigma of "Don't Ask Don't Tell' has far reaches beyond your military service. We want to know about it, and so as to hide your identity but allow you the opportunity to express your opinion anonymously we have set up this page for that purpose. We will promise to do two things: keep you anonymous by the form below, and relay this information gathered to the VA.

The information you provide may also be used in a national news article, as an alternate view of the effects of Don't Ask Don't Tell to give the American people your side of the story.

Rules for the study:

1. You should not use your name in any of the comments.
2. Be truthful in your reasons why you perfer not to use the VA.
3. If a bad experience at the VA give all the details without mentioning names.
4. No military disiplinary actions taken in military. (Clean service record.)

Privacy Concerns: No tracking devices are used to connect you to your comments. All information obtained by us will only be used for the purposes stated above. Any comments that are irrelevant or do not follow the rules will not be used in the study.

Questionaire:

Notes:
Branch of service lists all reserve components as well please read all when selecting.

*Branch of Service :	Select One Army Navy Air Force Marines Coast Guard National Guard Air Force Reserves Naval Reserves Army Reserves Marine Corp Reserves Coast Guard Reserve
Gender:	Select One Male Female Rather not say
Disabled Vet:	Select Yes No
Served In Combat:	Select Yes No

If in combat.. theater of operation:

Type of Discharge:

Select One Honorable General Dishonorable

Discharge based on lifestyle:

Select Yes No

Most important part of survey. Why do you hestitate to use the VA facilities? Be honest with your answer. Change can only come by making the VA aware.