Medical Anesthesia Consultants is dedicated to providing quality anesthesia  for all  patients who choose their healthcare in our area of service.  We would appreciate it if you would provide us  with feedback regarding your anesthetic experience with us.

Click here to fill out the questionnaire, or you may simply scroll down the page.

 
 
Post-Operation Questionnaire
 
Please complete out all areas and click "submit" when finished. Your feedback is valuable to our medical group.
 
Surgical Procedure:   Date of Procedure:
 
Name of Facility:   Name of Anesthesiologist:

Please rate the following questions using this scale:

1 = Excellent2 = Good3 = Satisfactory4 = Unsatisfactory
Was your anesthesiologist courteous and professional?
1 2 3 4
 
Was there adequate discussion of the risks of and alternatives to your planned procedure?
1 2 3 4
 
Were your concerns regarding your anesthetic and post-operative management addressed?
1 2 3 4
How would you rate your post-operative recovery in relation to:
Nausea?
1 2 3 4
 
Pain control ?
1 2 3 4
 
Shivering?
1 2 3 4
 
Other?
1 2 3 4
 
Please specify:
Were you satisfied with the level of anesthetic care during your procedure?
1 2 3 4
 
Comments:
 
 
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