Patient Satisfaction Survey Question Title * 1. Date of Service OK Question Title * 2. Name of Facility OK Question Title * 3. Anesthesia Provider's Name OK Question Title * 4. During the visit with the anesthesia team, I was able to ask the questions I wanted. Completely Agree Neutral Completely Disagree Clear i We adjusted the number you entered based on the slider’s scale. OK Question Title * 5. To what degree were you satisfied with the amount of information given by providers? Very Satisfied Neutral Not at all Satisfied Clear i We adjusted the number you entered based on the slider’s scale. OK Question Title * 6. The CRNA explained to me how I would feel after anesthesia. Completely Agree Neutral Completely Disagree Clear i We adjusted the number you entered based on the slider’s scale. OK Question Title * 7. To what degree did you find your anesthesia providers to be professional? Very Professional Neutral Not at all Professional Clear i We adjusted the number you entered based on the slider’s scale. OK Question Title * 8. I would want to have the same anesthetic again. Completely Agree Neutral Completely Disagree Clear i We adjusted the number you entered based on the slider’s scale. OK Question Title * 9. How satisfied were you with the care provided by anesthesia department? Very Satisfied Neutral Not at all Satisfied Clear i We adjusted the number you entered based on the slider’s scale. OK Question Title * 10. I would recommend the anesthesia team to others in my family. Yes No OK DONE