Please complete this form below in order for us to start the process of a possible interview on the "The Mental Health & Wellness Show." We will do our best to get within 2 weeks if we believe we might be a great fit for each other. If some of the questions are not applicable to you, please let us know in the comments! Thank you!

First Name *

Last Name *

Phone *

Email *

Please upload your headshot. This will be used for promotion of your episode. (500 X 500 PX) *

Facebook Link:

Twitter Link;

LinkedIn Link:

Website Link:

ClubHouse or Other Audio Ap Link

Have you been on a podcast before?

Instagram Link:

Link to book(s) you've written:

Business Name

Where is the number one place you'd like me to direct the listeners? (ie. Website/Instagram/Facebook) *

What are 3-4 questions you'd like me to ask you during the interview? *

What's a quick win that my listeners will get from listening to your interview: *

Please drop your bio below (150 words max.) *

What is the size of your email list? *

I will have a microphone for this interview. *

I will have a quiet environment to record the interview. *

I agree to the release and promotion of this interview on The Mental Health & Wellness Show & Dr. Tomi Mitchell Holistic Wellness Strategies. *

I agree to send out 1 email mention to my entire email list and 4 social media promotions during the week my episode is released. *

I understand Dr. Tomi Mitchell, and The Mental Health & Wellness Show, is not liable for any thing I say in this interview. *

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