Valley Anesthesiology Consultants Patient Survey
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The members of Valley Anesthesiology Consultants are committed to providing professional, attentive and compassionate care.

Please take a few moments to share your experience with us. Your feedback will help us improve our practice.
1. Please tell us the date of your procedure and the name of your surgeon/proceduralist.
2. Did your anesthesiologist clearly introduce himself or herself to you and your family?

3. Did your anesthesiologist mention he/she is a member of Valley Anesthesiology Consultants?
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4. Did your anesthesiologist clearly explain the type and plan of the anesthetic for your surgery? (space provided for additional comments)

Yes ____

No ____
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5. Were you and your family given an opportunity to ask questions and express concerns? Were these questions answered and concerns addressed to your satisfaction?

Yes ____

No ____

Comments
6. Do you feel like you received professional, attentive and compassionate care?
7. Would you like to have a member of Valley Anesthesiology Consultants provide anesthesia care for you or your family in the future?
8. How can we improve the Valley Anesthesiology Consultants experience for patients and family members?
9. If you would like to be contacted about your experience with Valley Anesthesiology Consultants, please send an email to patientsatisfaction@valleyanesth.org with the information listed below.
Thank you for your comments and suggestions.