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BariNation Partnership Interest Form
Thank you for your interest in collaborating and partnering with BariNation! Help us better understand your needs and we will be in touch soon!
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Email
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Your email
Your name:
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Your answer
What is your professional role?
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Your answer
Your phone number:
Your answer
What are your professional social media handles? (Instagram, TikTok, LinkedIn, Facebook, YouTube)
Your answer
What is your website address?
Your answer
What is your prefered method of contact?
Email
Phone Call
Text Message
Social Media Direct Message
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How did you discover BariNation?
At the ASMBS conference
Through a patient
Through a colleague
BariNation Podcast
BariNation YouTube channel
Instagram
Facebook
Google Search
Other:
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What kind of collaboration or partnership are you interested in exploring?
Education Colloboration
BariNation Partnership
Podcast Sponsorship
Having BariNation lead a support group/class/meetup for my practice
All of the aboce
I'm not sure yet
Other:
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What specifically are you interested in discussing with BariNation?
Your answer
Anything else you want us to know about you and your interested in working with BariNation?
Your answer
A copy of your responses will be emailed to the address you provided.
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