Media Request Form: Student Health Care Center Have questions, concerns or issues with this form? Please email firstname.lastname@example.org. Interview/Video Shoot/Image Request Form If you are a student reporter and/or member of the media and would like to request interviews, video shoot time, images and/or a logo from the University of Florida Student Health Care Center, please complete and submit the following form. Please note that due to the volume of requests received not all may be accommodated. Name* First Last Email* Phone*Name of media outletRequesting:*Staff interviewVideo shoot (specify scene preference in comments area)Other (specify in comments area)DEADLINE: Last possible date for interview/video shoot/receipt of images* DEADLINE: Last possible time for interview/video shoot/receipt of images* : HH MM AM PM PLEASE NOTE: Due to staffing and privacy restrictions, the majority of videos may only be shot on weekdays between 5 p.m. and 6 p.m.Interview platform (for staff interviews only)In-personPhoneNo preferenceAvailability (for in-person staff interviews only)Morning (between 8 a.m. and 12 p.m.)Afternoon (between 12 p.m. and 5 p.m.)No preferenceComments*Include interview topic and 1-5 questions, video shoot scene preferences or other requests here.EmailThis field is for validation purposes and should be left unchanged.