Mental Status Podcast - Interviewee Interest Form

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Hello and thank you so much for your interest in interviewing with Mental Status! I'm excited to get to know you and talk about what amazing things you can bring to the conversation.

Please take a few moments to answer the questions below to give me a better idea of who you are and what you'd like to talk about on the show. From there, if it looks like you're a good fit, I'll reach out to schedule a time for a brief discussion around specific topics you'd like to cover and to provide you with additional details about appearing on the show.

If you want more information about what to expect as a guest on the show, please read the Interviewee Information document here: https://docs.google.com/document/d/1cMurNAbKcmlmP7gphR49NxKqxfJtxb9c5hYLXD-u9lM/edit?usp=sharing

Can't wait!

-Meg

Email *

Full Name of Guest *

Phone Number (optional)

Best way to contact you for follow-up?

Phone

What is your line of work and job title(s)? *

What kinds of settings have you worked in? *

Private practice

Community mental health

Group practice

Non-profit

Government

Educational

Other:

Required

What certifications, areas of expertise, niches, or specialities do you have? *

Please select from the following general topics that you'd like to speak about. *

Burnout & identity

My personal burnout story/recovery story

Systemic & institutional reasons for burnout

Caregiver burnout

Prevention methods for burnout

Intervention methods for burnout

Postvention methods for burnout

Niche burnout

Advocacy for mental health professionals

Getting professional help as a therapist

Burnout & substance use/sobriety

Self compassion

Side hustles & burnout

Financial burnout

Burnout due to circumstances outside of work (death, divorce, illness, transition, moving, etc)

Burnout for highly sensitive professionals

Other:

Required

If you have additional suggestions for topics you'd like to discuss on the show that weren't listed above, or if you have a specific area of expertise that you feel makes you a great fit for the show, please share them here:

Please select "Agree" below to indicate that you understand that I cannot provide financial compensation for appearing on Mental Status. If you're not able to appear on the show without financial compensation, please select "disagree"—I will keep your interest form on file and may reach out if I'm able to offer compensation at some point in the future! *

Agree

Disagree

Anything else I should know about you, your work, or your burnout story? *

Send me a copy of my responses.

Submit

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