GatorWell Health Promotion Services
Media Interview Request Form
GatorWell Professional staff are more that happy to meet with the media and student reporters!
To ensure that we are well prepared for the interview, we request as much lead time as possible. Therefore, we may not be able to schedule the interview for the same day. We recommend that interviews be scheduled at least 2 or more days before story is due.
If you are having problems with this form please contact us: firstname.lastname@example.org
What is the topic area of your story?
Alcohol, Tobacco and Other Drugs
Body Image and Eating Concerns
Healthy Eating (Nutrition) & Active Living
Interpersonal Violence (including sexual violence)
Stress Reduction & Relaxation
Purpose of Request
Other (be specific)
Briefly describe the general idea the story. Please let us know if you are covering an event, services, response to a newly published study/research, etc.
If this story is for a class assignment, please provide a list of questions you may ask the Health Educator.
Do Not Fill This Out