Medical Intern Performance Evaluation Form

Medical Intern Performance Evaluation Form
Please complete this form to evaluate the performance of a medical intern. All feedback should be professional and non-sensitive.
Intern's Full Name
First NameLast Name
Evaluator's Full Name
First NameLast Name
Department/Rotation
Date of Evaluation
MonthDayYear
Date
Medical Knowledge

1
2
3
4
5
1 is Needs Improvement, 5 is Excellent
Clinical Skills

1
2
3
4
5
1 is Needs Improvement, 5 is Excellent
Professionalism

1
2
3
4
5
1 is Needs Improvement, 5 is Excellent
Communication Skills

1
2
3
4
5
1 is Needs Improvement, 5 is Excellent
Teamwork and Collaboration

1
2
3
4
5
1 is Needs Improvement, 5 is Excellent
Additional Comments or Recommendations
Should be Empty:

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