OB Anesthesia Patient Survey

Thank you for taking the time to evaluate Obstetrical Anesthesia Associates. Your input allows us to provide patients with the absolute best anesthesia care.

In this survey, you will be asked about the regional anesthesia/analgesia you received from Obstetrical Anesthesia Associates. This may include an epidural, spinal or a combined spinal-epidural block.

Question Title

* 1. How would you rate your overall satisfaction with the care you received from Obstetrical Anesthesia Associates?

Very Poor

Poor

Satisfactory

Good

Outstanding

Very Poor

Poor

Satisfactory

Good

Outstanding

Question Title

* 2. How would you rate the quality of information and/or education you received from Obstetrical Anesthesia Associates prior to your regional analgesia/anesthesia?

Very Poor

Poor

Satisfactory

Good

Outstanding

Very Poor

Poor

Satisfactory

Good

Outstanding

Question Title

* 3. How would you rate the response time of Obstetrical Anesthesia Associates for your regional analgesia during labor?

Very Poor

Poor

Satisfactory

Good

Outstanding

N/A

Very Poor

Poor

Satisfactory

Good

Outstanding

N/A

Question Title

* 4. How would you rate the effectiveness of the regional analgesia for your labor pain?

Very Poor

Poor

Satisfactory

Good

Outstanding

N/A

Very Poor

Poor

Satisfactory

Good

Outstanding

N/A

Question Title

* 5. Was the regional anesthesia effective for your cesarean section delivery?

Not effective

Somewhat effective

Satisfactory

Effective

Very effective

N/A

Not effective

Somewhat effective

Satisfactory

Effective

Very effective

N/A

Question Title

* 6. Was your regional anesthesia effective for post-cesarean section pain relief?

Not effective

Somewhat effective

Satisfactory

Effective

Very effective

N/A

Not effective

Somewhat effective

Satisfactory

Effective

Very effective

N/A

Question Title

* 7. Tell us about your experience with the Obstetrical Anesthesia Associates Staff

	Very Poor	Poor	Satisfactory	Good	Outstanding
Friendly and courteous	Friendly and courteous Very Poor	Friendly and courteous Poor	Friendly and courteous Satisfactory	Friendly and courteous Good	Friendly and courteous Outstanding
Respectful	Respectful Very Poor	Respectful Poor	Respectful Satisfactory	Respectful Good	Respectful Outstanding
Listened to your concerns	Listened to your concerns Very Poor	Listened to your concerns Poor	Listened to your concerns Satisfactory	Listened to your concerns Good	Listened to your concerns Outstanding
Knowledgeable	Knowledgeable Very Poor	Knowledgeable Poor	Knowledgeable Satisfactory	Knowledgeable Good	Knowledgeable Outstanding
Time spent with you	Time spent with you Very Poor	Time spent with you Poor	Time spent with you Satisfactory	Time spent with you Good	Time spent with you Outstanding

Question Title

* 1. How would you rate your overall satisfaction with the care you received from Obstetrical Anesthesia Associates?

Question Title

* 2. How would you rate the quality of information and/or education you received from Obstetrical Anesthesia Associates prior to your regional analgesia/anesthesia?

Question Title

* 3. How would you rate the response time of Obstetrical Anesthesia Associates for your regional analgesia during labor?

Question Title

* 4. How would you rate the effectiveness of the regional analgesia for your labor pain?

Question Title

* 5. Was the regional anesthesia effective for your cesarean section delivery?

Question Title

* 6. Was your regional anesthesia effective for post-cesarean section pain relief?

Question Title

* 7. Tell us about your experience with the Obstetrical Anesthesia Associates Staff

Question Title

* 8. We value your opinion. Please feel free to leave any comments.