AFFIRM Information Request | Rachel Hulstein-Lowe

Rachel Hulstein-Lowe, LICSW

Gender Diversity Expert, Transformational Parent Coach & Speaker

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Thank you for your interest in the A.F.F.I.R.M. Program

Please complete the short form below and you'll be one step closer to starting your journey.

After completing this questionnaire, you'll have access to my calendar where you can schedule an

Empowered Parent Breakthrough Session. During this FREE 20-minute session, you'll get a taste of the transformative content found in the program, as well as a clear sense of how our work together can help you and your family thrive.

I can't wait to meet you! - Rachel

A.F.F.I.R.M. Program Application

First name*

Last name*

Email*

Phone

City & State *

Age(s) of your gender-diverse kid(s): *

When did you know your kid(s) was gender-diverse?*

I heard about AFFIRM from:*

Rachel's Newsletter

Social Media

A friend/colleague shared the info

Podcast

Pediatrician or Other Health Provider

Other

(Check all that apply) My primary concerns as the parent of a gender-diverse kid: *

My kid's safety

Access to health care

My understanding of gender diversity

Bullying or other peer challenges

Transphobia/Transphobic legislation

Talking to friends, colleagues, and/or family members

Other

I've done other courses or coaching related to raising a gender-diverse kid:*

YES

Photos by Iryna Photography.