Takeover Request Form - Medicine Encompassed
Thank you for your interest in doing a takeover on the @medicine.encompassed Instagram account! By filling out this form, it is also indicated that Medicine Encompassed's Executive Social Media and Marketing Director, Instagram Lead Manager, Co-Chief Executive Officers, or other member of our leadership staff will do a takeover on your organization's account as well (preferably on the same day).

The founder of the organization (if there are co-founders, list ALL of them) should preferably fill out the Takeover Request Form!

It is NO LONGER required to be partnered with our organization in order to do an Instagram takeover with us!

QUESTIONS OR CONCERNS:
- Please feel free to DM us on Instagram!
- Email our Instagram Lead Manager, Majd Al-Aarg, at majd@medicine-encompassed.org!
- Email our Executive Social Media & Marketing Director, Lorena Rosati, at lorena@medicine-encompassed.org!
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Organization Name *
Founder's Name (or ALL Co-Founders' Names) *
Who, from your organization, will be hosting the takeover? *
Please state the NAME and the POSITION! (EX: CEO, Marketing Director, etc.)
Instagram Username *
This username should be the username for the account that we would takeover.
Preferred Method of Contact? *
Which day would be your FIRST preference to do a takeover? *
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Which day would be your SECOND preference to do a takeover (if your first preference does not work for us)? *
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Thank you for filling out Medicine Encompassed's Takeover Request Form! :)
We will get back to you shortly regarding the takeover through DM or email!
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