Clinical Evaluation Feedback
Please provide your feedback on the clinical evaluation session to help us improve our processes and training.
Full Name
*
First Name
Last Name
Your Role
*
Please Select
Student
Faculty/Instructor
Observer
Other
Date of Evaluation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please rate the following aspects of the clinical evaluation:
*
Rows
Poor
Fair
Good
Very Good
Excellent
Clarity of instructions
1
2
3
4
5
Professionalism of evaluator
6
7
8
9
10
Relevance of evaluation content
11
12
13
14
15
Feedback provided
16
17
18
19
20
Overall, how satisfied are you with the clinical evaluation experience?
*
1
2
3
4
5
Please share any additional comments or suggestions for improvement.
Submit Feedback
Should be Empty: