Roberto Estevez, M.D.

MEDIA INTERVIEW REQUESTS

Dr. Estevez is available by appointment for interviews with members of the media. If you are a reporter, editor, program host or producer, please take a moment to complete this form. We'll ge happy to contact you quickly to discuss the details. Thank you!


Your Name



Title


Media Outlet


Type of Media


Circulation/Coverage


Address ( include city, state, zip)


Phone Number


Email Address


Requested Date


Requested Time
  

Length


Interviewer


Location Preference


Topics


Date to Run


Format of the Segment


Special Notes & Information