Quote Request

Less Stress Instructional Services Quote Request Form

This form will provide us with the information necessary to provide a quote.  Please complete all portions of the form, and a coordinator will contact you to discuss
the program.

YOUR INFORMATION:

* Company / Group Name:

* Contact Name:

* Contact Email Address:

* City:

* State:

* Zip:

PROGRAM INFORMATION

Please check all programs that you would like a quotation on. Feel free to check multiple boxes.

Workplace / Community Emergency Care Training Programs:

Community/Workplace CPR/AED Training

First Aid Training

Oxygen Training

MERT (Medical Emergency Response Team) Training

Healthcare Provider / Professional Rescuer Training:

BLS/CPR for Healthcare Providers or Professional Rescuers

Advanced Cardiac Life Support (ACLS)

Pediatric Advanced Life Support (PALS)

Emergency Medical Technician (EMT) CEU's

First Responder (40-hour DOT program)

Safety and Compliance Training/Services:

Bloodborne Pathogens

Hazard Communication

Forklift / Industrial Powered Truck

Fire Extinguisher Training

EQUIPMENT NEEDS:

First Aid Equipment:

Automated External Defibrillator (AED) purchase

Automated External Defibrillator (AED) program lease

First Aid Response Bags/Equipment

CPR Barrier Devices

Emergency Oxygen Systems

Complete MERT Systems (AED/Oxygen/First Aid Supplies)

NUMBER OF TRAINEES

* How many individuals do you anticipate need training?

Why are you interested in this course (please list known regulatory requirements or other information you think might be helpful for us to know).

* Indicates Response Required