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Patient Forms → Binder Request Lifting up the voices in the LGBTQ+ community, near and far.

Binder Request Form

Over the last several years, HCAI has provided free chest binders to hundreds of LGBTQ+ youth – and we're here to help you, too. Request yours today by filling out the form below.

Please note, HCAI binder program ships chest binder ONLY throughout the US and Puerto Rico. If you live outside of the US, to request a free chest binder please visit Point of Pride website

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Please Note: Any information submitted using this form is transmitted securely and held in the strictest of confidence, protecting your privacy.