• CPR and Basic Life Support Pre-Assessment Form

    Use this form to help us understand your CPR/BLS background, confidence level, and any participation needs before the session.

  • Participant Information

  • Format: (000) 000-0000.

  • CPR / BLS Background

  • Have you taken CPR/BLS training before?*
  • Date of most recent training or certification
     - -
  • Primary reason for taking this pre-assessment*

  • Knowledge and Confidence Assessment

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  • Health, Mobility, and Participation Considerations

  • Do you have any physical limitations that could affect CPR/BLS practice?*
  • Do you need any accommodations for training participation?*

  • Scheduling and Follow-Up Preferences

  • Preferred class or session format*
  • Preferred days or times
  • Would you like follow-up instructions or reminders?*
  • Should be Empty:
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