Speaker Request Form | UT Physicians

Speakers Bureau

UT Physicians is home to a community of medical experts who are fortunate to serve the health care needs of patients from around the world.

With the extensive knowledge of our staff, 1,500 clinicians certified in more than 80 specialties and subspecialties, we can offer experts on a variety of topics for your upcoming event.

When requesting a speaker, please provide detailed information regarding your event or group, including the exact location and topics of interest.

Scheduling Instructions

Complete the Speaker Request Form and a member of the Department of Marketing and Communications will be in contact with you in 1-2 business days to confirm details.
Please schedule your request at least 30 days in advance from your event.
We require your audience have a minimum of 15 participants.
The requesting organization is responsible for any audio/visual (A/V) equipment required by the speaker.

Requester Information

Name*

First Last

Phone

Email*

Organization Name*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Event Information

Topic Requested*

Date of Event*

Event Location*

Street Address City State / Province / Region ZIP / Postal Code

Presentation Start Time*

: HH

MM

Presentation End Time*

: HH

MM

Type of Group*

Age of Group*

Available Audio Visual Tools

Estimated Attendance*

Additional Comments

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