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* 1. Reviewer:

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* 2. Please rate the candidate on the following:

  Excellent Good Satisfactory Unsatisfactory Unable to Judge
Professional Requirements & Attributes
Training & Experience
Potential Medical Staff Rapport - How well will he/she relate?
Potential Patient Rapport - How well will he/she relate?
General Medical Knowledge
Personal Attributes
Congenial Personality
Articulation
Enthusiasm
Confidence
Personal Rapport with Interviewer

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* 3. Can we meet the needs of the:

  Yes No Don't Know
Candidate?
Personal, Spouse and Family?

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* 4. Recommendations:

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* 5. Additional Comments:

T