JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Podcast Guest Pre-Screening Form
Please fill out this form to see if you would be a good fit for "The Dragonfly Connection" podcast with Amber Cook. Season 3 is all about helping others on their healing journeys - holistically with an emphasis on their mental health. There are no "right" or "wrong" answers. Please answer truthfully and don't worry about oversharing! Amber may reach out with questions. If selected, she will send you a link to schedule your conversation within two weeks.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
What's your first and last name?
*
Your answer
What pronouns do you prefer?
*
Your answer
Where are you located in the world?
Your answer
Do you have a computer/tablet/i-pad, good internet connection and quiet place to have our conversation?
*
Yes
No
Not Sure
Have you been a podcast guest before?
*
Yes
No
If "yes", please include URL's for at least one episode (that you have been a guest on)
Your answer
Are you a podcaster? If so, please share your Podcast URL.
Your answer
Please list your website URL and all social media links.
*
Your answer
How many followers do you have on Instagram? On Facebook?
Your answer
How active are you on social media?
*
Post at least once/day
Post several times/week
Post at least once/week
Rarely Post
Do you have an email list that you use for business purposes? If so, how many people are on that list?
*
Your answer
What's your favorite episode of the podcast, "The Dragonfly Connection" or (its first version) "The Holistic Healing Connection"? Why is it your favorite? (You can find it at
https://pod.link/1462587802
or on your favorite podcast platform).
*
Your answer
Tell us about yourself, your profession, and the work you do to help others on their healing journey? This isn't your "bio". You'll have a chance to submit that when you schedule your conversation time.
*
Your answer
Who do you serve in your work?
*
Anyone who needs my help
Men
Women
Non-Binary
Other:
Required
What types of healing methods/modalities have you used on YOUR own healing journey? Please list all forms of self-help and help from an outside source/professional.
*
Your answer
When thinking of ways your wisdom and expertise can help people on their healing journey, what's the #1 topic you would you like to discuss during our conversation?
*
Your answer
Have you published any online guides, books, music, movies, art? If so, please list names and URL's on how to find them.
Your answer
What are some questions you LOVE to be asked? List at least 3.
*
Your answer
What are some questions you HATE to be asked/something you don't want to talk about?
Your answer
Share at least one philosophy you follow, your life's motto, or quote you love. If it's someone else's words, please site the author.
*
Your answer
Are you comfortable with answering questions about yourself and your work on the fly?
Yes
No
Not Sure
Clear selection
If asked, would you be able to provide advice, tips, or a snippet of your work/technique with our listeners during the conversation?
*
Yes
No
Not Sure
A copy of your responses will be emailed to the address you provided.
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
