Health education Program reporting form

Date_____________
Trainers name: _____________________ _____________________

___________________

Place: ___________________________

Education title: _________________________________________________________________

Main points raised up during education____________________________________________

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______________________________________________________________________________

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Raised questions by clients

______________________________________________________________________________

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Number of clients trained:

Male_____

Female_____

Total______

Trainers’ name____________________ sign_____

____________________ sign_____