Subject Matter Expert and Interviewee Social Media and Tag Submission Form

If you are being interviewed or collaborating with INM, we want to make sure your name is spelled correctly, that we have your postnominal credentials correct, and that we’re tagging the appropriate social media accounts and linking to the right websites. Please submit your information here before your interview. There’s no guarantee we’ll use everything you submit, but there is no harm in providing whatever you’d like to share. You will only be asked to fill this out once. For any subsequent interviews, you may just email your interviewer with updated information. Please note any digital assets such as photos, videos, etc., please submit directly via email to your interviewer or respective INM team member.

Full name as you'd like it to appear

Need special characters for your name but don't know how to type them? Here's a resource where you can copy and paste them into this form: https://copychar.cc/ .

First Name

Last Name

Do you have any postnominal credentials? If so, please enter them below in the exact order and manner of capitalization that you'd like them displayed.

i.e. "ND, MPH" or "MD, PhD"

Are there any phonetic considerations when pronouncing your name? Emphasis on certain syllables? Please write your name phonetically below.

Know it would be helpful but don't know how? Here's a great resource: https://www.cmu.edu/hub/registrar/docs/phonetic-spelling-instructions.pdf.

First Name

Last Name

What content campaign or type are you submitting this form for?

If article or "other," please provide the topic and your interviewer/writer.

We want to make sure we refer to you by your accurate pronouns. What pronouns do you use?

Not sure what we're talking about? Learn more about pronouns and inclusive language here: https://lgbtqia.ucdavis.edu/educated/pronouns-inclusive-language

Email for INM team use ONLY

Email that can be shared publicly if people would like to follow up with you, schedule an appointment, etc.

You are not required to provide a public-friendly email address.

What is the username/handle for your public-facing/professional Instagram?

If none, please type N/A.

What is the username/handle for your public-facing/professional Facebook?

If none, please type N/A.

What is the username/handle or URL for your LinkedIn profile?

If none, please type N/A. Want to know how to find what we're looking for? Learn how here: https://www.linkedin.com/help/linkedin/answer/a522735/find-your-linkedin-public-profile-url?lang=en

What is the username/handle for your public-facing/professional Twitter?

If none, please type N/A.

What is the URL for your public-facing/professional YouTube channel?

If none, please type N/A.

If you want us to tag the naturopathic medical school you graduated from, please list it here.

Suggested hashtags to maximize impact and reach:

Please separate with a comma or period. This is not required - merely available for those who have experience with this and would like to provide suggestions.

What is the username/handle for your public-facing/professional TikTok?

If none, please type N/A.

Suggested keywords to maximize impact and reach:

Please separate with a comma or period. This is not required - merely available for those who have experience with this and would like to provide suggestions.

Other ideas for INM to use to maximize impact, reach, and strategy for this content:

This is not required - merely available for those who have experience with this and would like to provide suggestions.

Do you have a professional website for just yourself? If so please enter it below.

If none, please leave blank.

Do you have a website for your clinic or company that the public may visit to learn more about you, your work, or schedule an appointment? If so, enter it below.

If not, please leave blank.

Where are you based?

Please write location in the format of "City, State/Province" if you're a licensed healthcare provider. If you're from a small city, are not a practicing healthcare provider, or would like to request more privacy, please enter the region instead.

If you are a licensed/registered ND or healthcare provider, please list below the states in which you are licensed/registered.

If none, please type "NONE" if you are currently not licensed/registered, or N/A if you are not a healthcare provider.

Are there any other websites you'd like us to consider sharing such as news stories, press releases, books published, etc.?

By checking this box, you understand that INM has no obligation to use the above information or any materials provided.

INM can't guarantee that all of the above will be used, but we like to create this form as an opportunity for you to provide the most options for us to help maximize the impact and reach of content as is appropriate and deemed by INM and its' team and media partners.

By checking this box I acknowledge I have read, reviewed, and agree to this respective term(s).

Support the work of the Institute for Natural Medicine today and cultivate a happier, healthier future
through the growth and development of naturopathic medicine.

Support INM

The Institute for Natural Medicine is recognized as tax-exempt under IRS section 501(c)(3), which makes your gift to us tax deductible.

If you are considering a gift for furthering one of our sponsored projects, as required by federal tax law, we must inform you that once your donation has been processed, the gift is “complete” to the Institute for Natural Medicine. In other words, it becomes the property of the Institute for Natural Medicine with exclusive legal control over the donated funds. We make a good faith effort to honor a donor’s intent and utilize a gift for the purposes of the project named, however, the Institute for Natural Medicine reserves the right to re-grant gifts where, in our sole discretion, the recommended project is not furthering specified charitable purposes or when, for example, such project falls out of compliance with a federal or state regulatory authority. If the Institute for Natural Medicine cannot re-grant a donation to or for the purposes of a project that you have recommended, the Institute for Natural Medicine may in its sole discretion select an alternate recipient, expend the funds in furtherance of the intended charitable purpose itself, or contact you for a different recommendation. Please reach out to info@naturemed.org for more information on donating to INM's sponsored projects.