CLINIC OBSERVATION FORM

SABER College Physical Therapist Assistant Program

Clinical Observation Form 

CLINIC OBSERVATION FORM FOR APPLICATION TO PTA PROGRAM

As part of the requirements for application to the SABER College Physical Therapist Assistant Program, prospective students are required to spend a minimum of 20 hours of observation time in physical therapy practices. The student may complete the hours in more than one setting.  However, the student must complete at least a minimum of 10 hours in each practice setting. Scoring will be based on an average of the scores received from the Clinic Observation Forms.  Students are instructed to call the physical therapy clinic to request permission to observe and to request a specific time that is acceptable for their observation time.  The 20 required clinic observation hours must be completed within 1 year prior to the application deadline. Additional hours over 1 year will be considered for additional points.  All documentation of observation time must arrive at the school by the application deadline.  It is the student’s responsibility to make sure the college has received this documentation.

The following two pages are considered the “Clinic Observation Form.” This form should be used to document the applicant’s observation/volunteer time in a physical therapy clinic. All observation time reported must be documented on the observation form provided.  Other forms of documentation are not acceptable.  The information on this form is considered confidential.  Therefore, the observation form must be in a sealed envelope with stamped closure or supervisor’s signature written across the seal. Sealed envelope must be returned to the prospective student to submit as part of the application.

 

SABER College Physical Therapist Assistant Program

Clinic Observation Form

Student Name: __________________________________

I hereby give permission for a member of the SABER College PTA Program Admission Committee to contact this physical therapy department regarding details of my observation that may be in question.

Student Signature:  _______________________________                     Date: ______________

(Supervising PT/PTA completes this portion of the form)

Facility Name:

Facility Type:

Facility Address:

Facility Phone:

Name and position of person supervising student’s observation:

As part of the requirements for application to the SABER College Physical Therapist Assistant Program, prospective students are required to spend a minimum of 20 hours of observation time in physical therapy practices. The student may complete the hours in more than one setting.  However, the student must complete at least a minimum of 10 hours in each practice setting.  Students are instructed to call the physical therapy clinic to request permission to observe and to request a specific time that is acceptable for their observation time. The physical therapist or physical therapist assistant who supervises the student’s observation time should complete the form and sign the form. This form serves as documentation of observation time and as a reference if the person completing the form supervised the applicant’s observation time. The information on this form is considered confidential.  This observation form must be in a sealed envelope with stamped closure or supervisor’s signature written across the seal. The sealed envelope must be returned to the prospective student to submit with application to the PTA Program. The information that you provide will be used to assist the PTA faculty in determining the candidate’s qualifications for admission into the PTA program. No phone calls will be accepted. Thank you for assisting this student in gaining knowledge about the profession of physical therapy.

  1. Did this student handle setting up this observation time appropriately?

( ) exceptional ( ) adequate ( ) inadequate

  1. Was the student prompt and dependable during their time with you?

( ) exceptional ( ) adequate ( ) inadequate

  1. Did the student demonstrate the ability to establish communication with you and the staff?

( ) exceptional ( ) adequate ( ) inadequate

  1. Did the student demonstrate the ability to establish communication with patients and their families?

( ) exceptional ( ) adequate ( ) inadequate

  1. Did the student appear interested and ask appropriate questions?

( ) exceptional ( ) adequate ( ) inadequate

  1. Did the student demonstrate the ability to assume appropriate responsibility?

( ) exceptional ( ) adequate ( ) inadequate

  1. Was the student’s appearance appropriate for the practice setting?

( ) exceptional ( ) adequate ( ) inadequate

  1. Did the student demonstrate understanding of the roles of the PT/PTA and the practice setting they observed?

( ) exceptional ( ) adequate ( ) inadequate

  1. Did the student demonstrate ability to follow verbal and/or written instructions?

( ) exceptional ( ) adequate ( ) inadequate

  1. Based on the student’s behavior in your practice, please rank the student as:

( ) An excellent candidate for the PTA program

( ) Should be considered for the PTA program

( ) A poor candidate for the PTA program

Comments:

Number of total hours the student observed at this practice: ____________________________

Signature of PT or PTA that supervised student’s observation _____________________________

Date (Required)_____________________________________