Physical Therapist Assistant Program Observation Form printable pdf download

Physical Therapist Assistant Program Observation Form

PHYSICAL THERAPIST ASSISTANT PROGRAM

OBSERVATION FORM

Blue Ridge Community & Technical College

Physical Therapist Assistant Program

You are required to complete a minimum of 20 volunteer/observation hours divided

between at least 2 distinctly different physical therapy practice settings. Mail a

completed form for each of the clinics you visit by April 10th to:

Blue Ridge Community and Technical College

ATTN: Dr. Chrystal McDonald

5550 Winchester Avenue

Martinsburg, WV 25405

Date Visited

Hours

Please have this section completed and signed by a physical therapist or physical

therapist assistant at the clinic you visit.

Introduces self to staff.

Yes

Listens attentively.

Yes

Asks questions to aid learning.

Yes

Meets expectations for attendance and punctuality.

Yes

Responds in an appropriate manner to requests.

Yes

Respects confidentiality.

Yes

Converses appropriately with staff and patients.

Yes

Other comments:

______________________________________________________________________

Applicant Name:________________________________________________________________

Clinic Name:___________________________________________________________________

Physical Therapist or PTA:________________________________________________________

Printed Name

Signature

Physical Therapist Assistant Program Observation Form