Electrotherapy Training Acknowledgement
Please complete this form to confirm your participation in and understanding of the Electrotherapy Training session.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Date of Training Session
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Trainer's Name
*
I acknowledge that I have received training on the following topics:
*
Safe operation of electrotherapy equipment
Contraindications and precautions
Emergency procedures
Proper maintenance and cleaning
Other
Signature
*
Submit Acknowledgement
Submit Acknowledgement
Should be Empty: