Client Education Observation Survey
Please complete this form to provide feedback and observations on a client education session.
Observer Name
*
First Name
Last Name
Client First Name
*
Session Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Type of Education/Topic
*
Please Select
Health Education
Financial Literacy
Technology Training
Life Skills
Other
Areas Observed (Select all that apply)
*
Client Engagement
Understanding of Material
Participation in Activities
Communication Skills
Application of Knowledge
Other
Overall Effectiveness of the Education Session
*
1
2
3
4
5
Additional Comments or Observations
Submit Observation
Should be Empty: