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?

* 4. Did your anesthesiologist clearly explain the type and plan of the anesthetic for your surgery? (space provided for additional comments)

Yes ____

No ____

* 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 ____


* 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 with the information listed below.

Thank you for your comments and suggestions.
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