Radio Show Questionnaire

Propose Your Radio Show to be on Scientific Healing with Dr. Anastasia Chopelas.  If you've already spoken with me, please fill in the form: you are already approved.  

Click the button to get started.


Question 1 of 10

Enter Your Name

Question 2 of 10

Enter Your 200 word biography

Question 3 of 10

Upload a minimum of 1400x1400px photo of yourself.


Question 4 of 10

Proposed interview topic.  Remind me here, if we've already spoken.

Question 5 of 10

URL of free offer to audience, if any.  Otherwise write none.

Question 6 of 10

Your website URL.

Question 7 of 10

Questions Anastasia could ask you, up to 6.  If the standard set of questions work for you, write none.

Question 8 of 10

Social media url's, if you have accounts, including Facebook, Twitter, Instagram, etc.  Ex:, so I can cross promote you.

Question 9 of 10

Your best phone number to reach you in case something goes wrong.

Question 10 of 10

How are you going to promote your show?


Mail my list


On at least 2 social media platforms



Confirm and Submit