SRHR Map: Add a New Service
Instructions
We appreciate you taking the time to fill out our form. The more information you can provide, the better our resource will be. Should you want to select multiple options in our dropdown menu questions, hold the Control button (Command on a Mac) while clicking on the options that you wish to select.
Your Name
First Name
Last Name
Your Phone Number
Your E-mail
example@example.com
What is your connection to this service?
Service user
Employee
Owner/Operator
Volunteer
Other
Service Name
*
The name of the service that you wish to add to SRHR Map. For example, Planned Parenthood, or Jones Community Health Centre.
Service Description
Please don't include information that is time sensitive, for example information about upcoming one-time events. A good service description should help answer frequently asked questions or help potential service users determine if your service is the right fit for them: For example, What types of services or programs are offered? How can people learn more? What are the eligibility requirements? What is the ethos of the service? How does lived/living experience inform your work?
Service Format
In-person
Virtual
Hybrid
Service Address
Street Address
Street Address Line 2
City
Province
Postal Code
Service Tags
Business
Civil Society
Community Health Centre
Crisis Pregnancy Centre
Doula
Health Centre
Hospital
Midwife
NGO
Nursing Station Clinic
Obstetrician and Gynecologist
Pharmacy
Sexual Health Clinic
Shelter
Supervised Consumption Site
Therapist/Counsellor
Transitional Housing
Any other tags that describe this service
Please let us know any additional "tags" or descriptors that describe the service.
Services Offered
For example, educational programming, HIV testing, IUD removal, Pap tests, needle exchange, harm reduction supplies, postpartum support, community workshops, prenatal classes, STI testing, fertility testing, etc.
Service Access
Drop-in
NO appointment needed
NO referral required
Urgent same-day appoints available
Encouraged to schedule an appointment
Access by appointment only
Referral required
Additional access details
Service Area (catchment area)
The geographical area served by the service. For example, "available to all residents of Ontario", Greater Toronto Area (GTA), Catchment area: Steels Ave South to Lake Ontario, East to Port Union Road, and West to Kipling Avenue, etc.
Service Phone Number(s)
Please include descriptors where necessary and any/all extensions, area codes, etc. For example: Office line 123-456-7890; Crisis Hotline: 1-800-GET-HELP
Fax
Fax Number
Website
Facebook Link
Instagram Link
Twitter Link
Target Population
Aboriginal
African
Asian
BIPOC
Black
Children
Elders
Existing clients only
Homeless
Immigrants
Indigenous
Jamican
Men
Middle Eastern
Newcomers
Parents
People experiencing domestic violence
People living in catchment area
People living with HIV/AIDS
Recreational drug users
Registered students
Sex workers
Survivors of sexual violence
Women
Women experiencing violence
Youth
The group(s) of individuals that the service serves.
Additional Target Population Details
For example, "youth ages 12-29", or "all self-identified women including two-spirited, cisgender, and transgender women, and her children, within the GTA".
Service Languages and/or Dialects
English
French
Access to an interpreter 24/7
Interpreter services must be arranged in advance
Access to translation services 24/7
Translation services must be arranged in advance
Afghan (Dari)
Afrikaans
Akan
Albanian
Amharic
Arabic
Arabic (Lebanese)
Arabic (Sudanese)
Armenian
Armenian ( Eastern)
Armenian (Western)
Ashante
Ashanti
ASL (American Sign Language)
Assyrian
Azerbaijani
Azeri
Bajuni
Bambara
Basque
Behdini
Belorussian
Bengali
Berber
Bosnian
Bravanese
Bulgarian
Burmese
Cambodian
Cantonese
Cantonese
Catalan
Cebuano
Chaldean
Chamorro
Chao-chow
Chavacano
Chin
Chinese
Chiu Chow
Chuukese
Cree
Creole
Creole (Haitian)
Croatian
Czech
Dakota
Danish
Dari
Deaf Interpreter (DI)
Dinka
Diula
Dutch
Edo
English
Estonian
Ewe
Fante
Farsi
Fijian
Filipino (Tagalog)
Finnish
Flemish
French
Fujian
Fukienese
Fukinese (Southern)
Fula
Fulani
Fuzhou
Ga
Gaddang
Gaelic
Gaelic-irish
Gaelic-scottish
Garre
Georgian
German
Gorani
Greek
Gujarati
Haitian
Hakka
Hakka-chinese
Hassaniyya
Hausa
Hebrew
Hindi
Hmong
Hoiping
Hungarian
Ibanag
Ibo
Icelandic
Igbo
Ilocano
Indonesian
Italian
Japanese
Javanese
Kanjobal
Kannada
Karen
Karenni
Kashmiri
Kikuyu
Kinyarwanda
Kirundi
Korean
Kosovan
Kotokoli
Krio
Kurdish
Kurdish (Sorani)
Kurmanji
Ladino
Lakota
Laotian
Latvian
Lingala
Lithuanian
Low German
Luganda
Luo
Luxembourgeois
Maay
Macedonian
Malagasy
Malay
Malayalam
Maltese
Mandarin
Mandarin (usually Simplified Chinese)
Mandingo
Mandinka
Marathi
Marshallese
Mien
Mina
Mirpuri
Mixteco
Moldavan
Moldovan (Romanian)
Mongolian
Montenegrin
Navajo
Neapolitan
Nepali
Nigerian
Norwegian
Ojibway
Oromo
Oromo (Western)
Pahari
Papiamento
Pashto
Patois
Persian (Farsi)
Pidgin
Polish
Portuguese
Portuguese (Brazil)
Portuguese (European)
Pothwari
Pulaar
Punjabi
Putian
Pwo (Karen)
Quichua
Romanian
Russian
Samoan
Sango
Serbian
Serbo-Croatian
Sgaw (Karen)
Shanghainese
Shona
Sichuan
Sicilian
Sinhalese
Slovak
Slovenian
Somali
Soninke
Sorani
Spanish
Sudanese
Sundanese
Susu
Swahili
Swedish
Sylheti
Sylhetti
Tagalog
Taiwanese
Tajik
Tamasheq
Tamil
Telugu
Thai
Tibetan
Tigre
Tigrinya
Toishan
Toishanese
Toucouleur
Tshiluba
Turkish
Twi
Ukrainian
Ukranian
Urdu
Uyghur
Uzbek
Vietnamese
Visayan
Welsh
Wolof
Yiddish
Yoruba
Yupik
Languages/dialects that services are offered in.
Additional Language Details
For example, can service users always access services in their language of choice or do arrangements need to be made beforehand.
Service Availability
Morning
Afternoon
Evening
Weekdays
Weekends
24/7
Upon Request
Ocassional
Service Cost
Free
Pay What You Can
Sliding Scale
Payment Plans Available
Paid
Private insurance accepted
Fully covered by OHIP
Fully covered by the Interim Federal Health Program (IFHP)
Additional Cost Details
For example, what specific types of insurance are accepted? Are some services covered and others are not? Are services covered for some individuals not not for others? What are the nuances of cost?
Transportation
Transportation provided
Transportation costs refunded
Accessible by public transit
Free parking
Street parking
Paid parking
Accessibility Details
Wheelchair Accessible
Partially Accessible
NOT Accessible
Accessible parking spaces
Accessible entrance
Ramp to entrance
Wide doorways
Elevator
Lift
Automatic door opener
Barrier-free paths of travel
Barrier free bathrooms
Lowering exam tables
Braille
Mechanical ceiling lift
Additional Accessibility Details
For example, "Partially accessible, the reception desk does not feature a lowered counter and the elevator does not feature braille or voice/tone features."
Identification Requirements
No identification required
Identification required
Health card required
Student identification required
Service Waitlist
Yes
No
Additional Waitlist Details
For example, "Services fully booked until June 2023".
Service Providers
Abortion Doula
Acupuncturist
Art Therapist
Attorney
Audiologist
Babywearing Educator
Birthkeeper
Birthworker
Bushwoman
Caseworker
Certified Carseat Technician
Certified Yoga Instructor
Child Birth Educator
Chiropractor
Counselors
Dietitian
Doula
Educator and Early Childhood Educator
EMDR providers
Family Doctor
Full-Spectrum Doula
Herbalist
Homeopath
Hypnotherapist
Infant Massage Instructor
International Board Certified Lactation Consultant (IBCLC)
Kinesiologist
Lactation Consultant
Lawyer
Massage Therapist
Medical Laboratory Technologist
Medical Radiation Technologist
Naturopath
Nurse
Nurse Practitioner
Occupational Therapist
Paralegal
Pelvic Health Physiotherapist
Pharmacist
Pharmacy Technician
Physician
Physician or Surgeon
Physiotherapist
Postpartum Doula
Prenatal Educator
Psychologist
Psychotherapist
Public Health Nurse
Registered Midwife
Registered Nurse (RN)
Registered Practical Nurse (RPN)
Registered Psychotherapist
Registered Psychotherapist (Qualifying)
Registered Social Worker
Reiki Healer
Reiki Practitioner
Sexual Assault Nurse Examiner
Sleep Consultant
Social Service Worker
Social Worker
Speech-Language Pathologist
Spiritual Psychotherapist
Therapist
Traditional Chinese Medicine Practitioner
Traditional Midwife
Yoga Teacher
Yoga Therapist
What service providers are providing services?
Additional Service Provider Details
Please include the categories of any service providers not listed above or additional information. For example, "All of our staff are living with HIV/AIDS" or list relevant types of service providers that are not included above.
Service Provider Demographic
2SLGBTQQIA
Aboriginal
African
Asian
BIPOC
Black
Elder
Fat
Immigrant
Indigenous
Jamican
Men
Middle Eastern
Neurodiverse
Newcomer
Parent
Person living with a disability
Person living with HIV/AIDS
Queer
Recreational drug user
Sex worker
Woman
Youth
What identities do the service provider(s) hold?
If you have any additional notes about this service, please include them here.
File Upload
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