Podcast Guest Interest Form Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Areas of PracticeCredentialsEducational BackgroundSpecialties or Areas of ExpertiseYears of Experience in your FieldWhat topics would you like to discuss on the podcast?Do you have any special offers for our listeners?Would you like to market any of your products?Terms of Use *I UnderstandBy submitting this form via web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted electronic messaging and wish to continue despite those risks. By clicking "I Understand" you agree to hold The Academy of Integrated Mental Health and their website developers harmless for unauthorized use, disclosure, or access of your information sent via this electronic means.Submit