Facility seen at time of service

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* 1. Facility seen at time of service

Age

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* 2. Age

What is your gender?

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* 3. What is your gender?

What is your ethnicity? (Please select all that apply.)

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* 4. What is your ethnicity? (Please select all that apply.)

Was the pre-operative anesthesia care up to your standards of care?

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* 5. Was the pre-operative anesthesia care up to your standards of care?

How was the communication with your anesthesiologist prior to surgery?

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* 6. How was the communication with your anesthesiologist prior to surgery?

Did you find your anesthesiologist to act in a professional manner?

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* 7. Did you find your anesthesiologist to act in a professional manner?

Did your anesthesiologist explain the risks and benefits to your satisfaction?

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* 8. Did your anesthesiologist explain the risks and benefits to your satisfaction?

Was the anesthesiologist’s explanation of what to expect before surgery to your satisfaction?

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* 9. Was the anesthesiologist’s explanation of what to expect before surgery to your satisfaction?

Was the anesthesiologist’s explanation of what to expect after surgery to your satisfaction?

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* 10. Was the anesthesiologist’s explanation of what to expect after surgery to your satisfaction?

Was the care you received in the recovery room to your satisfaction?

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* 11. Was the care you received in the recovery room to your satisfaction?

If you had any post-op symptoms or discomfort in the recovery room, were you treated to your satisfaction?

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* 12. If you had any post-op symptoms or discomfort in the recovery room, were you treated to your satisfaction?

A sore throat or hoarseness is common after general anesthesia. If this occurred to you after your surgery, did the discomfort go away after 24 hours?

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* 13. A sore throat or hoarseness is common after general anesthesia. If this occurred to you after your surgery, did the discomfort go away after 24 hours?

Overall, how satisfied were you with your anesthesia care?

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* 14. Overall, how satisfied were you with your anesthesia care?

Would you recommend the physician to others?

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* 15. Would you recommend the physician to others?

If there is any way we can improve our services to you, please tell us about it

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* 16. If there is any way we can improve our services to you, please tell us about it

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