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Dental Hygiene Department Clinic Instructor Evaluation
RequiredRequired Question(s)
Required 1.

Clinic Section

Pre Clinic
Required 2.



50 characters left.

Please answer the following questions pertaining to the instructor(s) you had on this last rotation. If you had more than one instructor, you need to fill out an evaluation for each instructor.

Required 3.

Name of Instructor:


50 characters left.
Required 4.

I have worked with this instructor approximately ____________ times.

5 - 8
9 - 16
17 - 24
Required 5.

Please rate the following: This Instructor...

 Always Usually Sometimes   
uses explanations that help me understand.   
connects classroom theory with clinical experiences.   
provides guidance in analyzing and improving my performance.   
helps me to identify my strengths.   
helps me to identify my weaknesses.   
provides meaningful written documentation of my performance.   
responds to my requests for instructional assistance.   
Required 6.

Please rate the following: This Instructor...

 Always Usually Sometimes   
distributes his/her time fairly among assigned students.   
evaluates my performance in a manner consistent with the department guidelines.   
is prompt in signing and returning day sheets and clinic records to me.   
permits me adequate time for critical thinking and problem solving, aiding with the development of my judgment.   
uses clinical skills consistent with department policy and protocol.   
demonstrates concern for my patients.   
encourages questioning.   
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