Podcast Guest Intake Form

1

Full Name* This field is required.

First Name

Last Name

2

Preferred Name (for the show)

3

Pronouns

4

Email Address* This field is required.

example@example.com

5

Phone / WhatsApp Number

Please enter a valid phone number.

6

City & State/Country* This field is required.

7

Time Zone* This field is required.

8

Short Bio (3–6 sentences)* This field is required.

9

Your Title/Role (e.g., Author, Pastor, Therapist, Coach, Entrepreneur)

10

Organization/Ministry/Business Name

11

Website

12

Instagram

13

Facebook

14

YouTube

15

TikTok

16

17

Headshot Upload (JPG/PNG preferred)

Drag and drop files here

Select files to upload

Max. file size: 10.0MB

Upload a File

18

What topic would you like to discuss on the podcast?* This field is required.

19

Briefly share your story/testimony related to this topic* This field is required.

20

Key points you want listeners to take away (list 3–5 bullet points)* This field is required.

21

Are there any topics you prefer NOT to discuss?

22

Any faith-sensitive or trauma-sensitive considerations we should be aware of?

23

Preferred Recording Format* This field is required.

Zoom (Video)

Audio-only

In-person (if local)

24

Availability (Select all that apply)* This field is required.

Weekday mornings

Weekday afternoons

Weekday evenings

Weekends

Flexible

25

Provide 2–3 date/time windows that work for you* This field is required.

26

Do you have a quiet space + reliable internet for recording?* This field is required.

Yes

No

Not sure

27

Do you have a microphone/headset?

Yes

No

Not sure

28

Consent to video recording* This field is required.

Yes

No

Prefer audio only

29

Episode Title Suggestion (optional)

31

Promotion details (if Other selected above)

32

Preferred Link for Promotion (URL)

33

Preferred Social Handles to Tag

34

I give Broken Vessels Podcast permission to record, edit, and publish this episode across podcast and social platforms.* This field is required.

I agree

35

I confirm I own the rights to my story and any materials I share, and I understand the episode may be edited for clarity and length.* This field is required.

I confirm

36

Anything else you want the host to know?

37

Tell us what setup you’ll be using (phone, laptop, etc.)

38

Any specific privacy requests?