Facts About Fast Brains Podcast Interview Booking Form

Name of guest*

First NameLast Name

Name of parent/carer*

First NameLast Name

Age of guest*

Guest gender*

FemaleMaleNon BinaryPrefer not to say

Contact email*

Contact phone number*

Where in the world are you located?

What days/times generally suit for an interview*

How would you prefer the interview to take place?*

In person (inner west, NSW, Australia location)Online

If online, do you have a quiet space, headphones and access to a smartphone or computer for the interview?

YesNo

Is it OK if we record and share video (as well as audio) from the session?*

YesNo

Would it be OK if we chat before the podcast to get to know each other a bit?

YesNo

Tell us a little more about your ADHDer (their quirks and superpowers)*

Is there anything else you think we should know about your ADHDer?*

Please upload a head shot of your ADHDer that you'd be happy to have shared on Facts About Fast Brains social media.

Browse Files

I hereby grant to Facts About Fast Brains, its affiliates, agents or successors, and assign the right and permission to record, use, publish, stream live, offer for sale, or otherwise distribute any audio or video interview or session with the guest named above in this form.

Right and permission includes (but it is not limited to) the name of the guest, recorded audio or video, photograph or likeness, biographical information, handouts or any material based upon or derived. This grant of permission does not include the release of any of guest’s confidential information. For purposes of the paragraph, ''confidential information'' is defined as home address, email address, telephone numbers or date of birth of guest.

Signature of Parent/Carer*