Roberto Estevez, M.D.

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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