Healthcare Professional Pre-test Assessment Form
Complete this pre-test assessment before your test so your background, readiness, and logistics can be reviewed.
Professional Background
Professional role
*
Please Select
Physician
Nurse
Pharmacist
Physician Assistant
Nurse Practitioner
Therapist
Technician
Allied Health Professional
Other
Clinical area or specialty
*
Years of professional experience
*
Current work setting
*
Please Select
Hospital
Clinic
Primary Care Practice
Specialty Practice
Urgent Care
Long-Term Care Facility
Academic Medical Center
Community Health Center
Telehealth/Remote
Other
Pre-test Knowledge and Preparation
Prior experience with this topic or test format
*
None
Limited
Moderate
Extensive
Other
Self-rated confidence level
*
Not confident
1
2
3
4
5
6
7
8
9
Very confident
10
1 is Not confident, 10 is Very confident
Familiarity with key protocols or concepts
*
Rows
Not familiar
Somewhat familiar
Familiar
Very familiar
Core clinical protocols
1
2
3
4
Safety and infection control
5
6
7
8
Documentation standards
9
10
11
12
Emergency response procedures
13
14
15
16
Recent preparation activity or study completion
*
Completed full review
Completed partial review
Started but not finished
Have not prepared yet
Other
Practical Readiness and Constraints
Preferred assessment time
*
Submit
Should be Empty: