Speaker Request Form

At UnityPoint Health - Des Moines, we welcome the opportunity to share our expertise with the community. Our healthcare professionals are available to speak to your organization about a number of different health topics.

We just need to know a little more about your event and/or organization. Please complete the requested information below and we will do our best to make sure one of our experts can speak to your group. When you have completed this form, please hit the submit button at the bottom. Please allow at least three weeks notice in order for us to find the best person to speak at your event.

If you have any questions, please call our Public Relations Department us at 515-241-6302.

Contact Name * Daytime Phone * Email Address * Organization * Street Address * City State Zip * Possible Date(s) * Possible Time(s) * Location * Time allotted for speaker * Are there any other details we need to know? * Event InformationAudienceAge Range * Gender *MaleFemaleBoth Number of People * Topics: Tell us what topics may interest your audience. *