Core Care Plus Rehabilitation Logo

Clinical Rotation Facility Feedback Form

Your feedback helps us enhance the clinical education experience for all PT students. All responses are confidential and greatly appreciated.

0% Complete
👤

Student Information

Please provide your basic information to help us process your feedback.

⭐

Overall Experience

Rate your general satisfaction with this clinical rotation.

1 = Poor2 = Below Avg3 = Average4 = Good5 = Excellent
Overall satisfaction with this clinical rotation
Would you recommend this facility to future PT students?
🏥

Clinical Environment & Resources

Evaluate the physical space, equipment, and available resources.

1 = Poor3 = Average5 = ExcellentN/A = Not Applicable
Adequacy of equipment and resources for student learning
Cleanliness, safety, and overall condition of the facility
Access to patient cases appropriate for PT student learning
Availability of reference materials, EMR access, and clinical tools
🎓

Clinical Instruction & Supervision

Assess the quality of guidance and mentorship from your Clinical Instructor.

1 = Poor3 = Average5 = ExcellentN/A = Not Applicable
Quality and consistency of supervision provided by the CI
CI's ability to explain clinical concepts and provide clear instruction
CI's availability and approachability when you had questions
Frequency and quality of constructive feedback received
Encouragement of critical thinking and independent clinical reasoning
📚

Learning Opportunities

Evaluate the breadth and depth of clinical learning experiences available.

1 = Poor3 = Average5 = ExcellentN/A = Not Applicable
Variety of patient diagnoses and conditions encountered
Opportunities to practice and develop hands-on clinical skills
Exposure to interdisciplinary team collaboration and communication
Opportunities to observe and participate in clinical documentation
Opportunities to develop therapeutic patient communication skills
🌱

Professional Development

Reflect on your growth as a future physical therapy professional.

1 = Poor3 = Average5 = ExcellentN/A = Not Applicable
This rotation prepared me for entry-level physical therapy practice
Support for developing clinical decision-making and problem-solving skills
Encouragement of professional behavior, ethics, and standards of practice
Opportunities for self-reflection, goal-setting, and personal growth
🤝

Facility Culture & Support

Evaluate the overall environment, staff support, and student integration.

1 = Poor3 = Average5 = ExcellentN/A = Not Applicable
The facility provided a welcoming and inclusive environment for students
Support and approachability of facility staff beyond the CI
Quality and thoroughness of student orientation at the start of the rotation
Communication and coordination between the facility and your academic program
💬

Open-Ended Feedback

Your detailed comments help us make meaningful improvements. All fields are optional.

Fields marked with * are required. All responses are kept confidential.

Staff / Admin Access