Physician Media Participation Form

Physician Media Participation Form

Are you interested in participating or nominating someone for media interview opportunities?

Palomar UC San Diego Health is excited to highlight our extraordinary team. Each opportunity you participate in you are welcome to share on your personal platforms. All opportunities are prerecorded and not live.

    I’m interested in... *

    Nominee's First and Last Name

    I’m interested in participating in...

    Please select all that apply. *

    They're interested in participating in...

    Please select all that apply. *

    Are you comfortable speaking Spanish? *

    Are they comfortable speaking Spanish? *

    Do you have any scheduling conflicts or preferences? (i.e. I am not available to film/record on Mondays or Tuesdays in the morning because I see patients)
    Please note them below. *

    Please provide us with your title as you would like it to appear on the specified mediums during your interview. (i.e. First name, Last name, Credentials and Title/Service Line) *

    First Name: *

    Last Name: *

    Credentials: *

    Title or Service Line *

    Please provide the email that should be used for coordinating. InnoVision Marketing Group, the agency of record for Palomar Health, will provide more details through email on opportunities based on your selections above. *

    Last updated: June 15, 2026