Request for Interview or Event Facilitation
Please complete this questionnaire and we will follow-up if this project is a good fit for Dr. Theresa
Sign in to Google to save your progress. Learn more
Email *
First Name:
Last Name:
Website:
How did you hear of Dr. Theresa?
Please describe the theme of your show / project / event:
What is the goal of your show / project / event?
How much have you engaged with Dr. Theresa's content to know that it is aligned with your work?
Why do you feel Dr. Theresa is a good guest for your show / project / event?
Please share more about your background:
What is the time commitment for the interview, project, or event?
Who is your primary audience?
What is your average number of plays per episode?
How many subscribers do you reach through your email list?
How many followers do you have on Social Media platforms?
Anything else you'd like to share?
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Genevieve Wachutka. Report Abuse