Media Requests - PrimaryOne Health

Media Request Form

Please complete this form if you are a member of the media requesting more information. Submit the request at least a week prior to the date which you will need a response by. Submission of this form does not guarantee that PrimaryOne Health will agree to participate or provide more information.

Name(Required)

First Last

Organization Name(Required)

Email(Required)

Phone(Required)

What will you use this information for?(Required)

Please elaborate on what this will be used for.

What resources are you seeking?(Required)

General information/press release

Interview (phone/Zoom)

Interview (in-person)

Photo(s)/video(s)

Other

What other resources will you need?

Which department does your request pertain to?(Required)

You indicated "other." Please elaborate on the nature of your request.

Story Topic(Required)

Deadline

Interview Questions, if any