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1. Please complete this survey and submit.

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2. The Clinical Instructor was prepared for my first day and oriented me to the department.

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3. The Clinical Instructor was familiar with the policies of the facility in which he/she worked.

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4. The Clinical Instructor introduced me to other employees of the department.

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5. The Clinical Instructor was confident and instructed me in the proper departmental proceedings.

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6. The Clinical Instructor was supportive of my knowledge of modalities, and assisted me when needed.

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7. The Clinical Instructor was familiar with my didactic work prior to this clinical experience.

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8. The Clinical Instructor spent adequate time with me, but allowed me some freedom with patient care.

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9. There was some good interaction with other PT personnel as well as other personnel in the facility.

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10. The Clinical Instructor allowed adequate time to complete my clinical duties.

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11. I would recommend this Clinical Instructor to other students.

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12. Please add any additional comments you wish to make about this Clinical Instructor or the overall clinical experience.

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