JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Wild Women podcast interview
Please fill out the form so I can see if you will be suitable for the Wild Women podcast. I'll be in touch if I think you're suitable
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name:
*
Your answer
What is your email address? (Only used to contact you if I think you're suitable for the podcast)
*
Your answer
Have you suffered anxiety and/or depression and used nature and the outdoors as a way to heal? If yes, please provide details:
*
Your answer
Do you or have you suffered a physical illness or disability and have used nature and the outdoors as a way to heal? If yes, please provide details:
*
Your answer
What outdoor activities have you taken up?
*
Hiking
Rock Climbing
Horse riding
Snow sports
Running
Swimming
Surfing
Diving
Bouldering
Biking
Canoeing/Kayaking
Other:
Required
If 'Other' was selected, please specify...
Your answer
Tell me your story of healing. Include as much info as possible.
Your answer
Would you be happy to answer questions regarding your mental/physical illness? Questions will be sent in advance before the interview takes place. This podcast will be broadcast on WayfaringKiwi.com to my audience of 20,000+ readers
*
Yes
No
It depends what the questions are
Do you have a blog or business? Drop your website/social media links below:
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Wayfaring Kiwi.
Report Abuse
Forms
