Longmont Anesthesia Associates Post-op Questionnaire

Please fill in the following information and click on the Submit button below:

What type of surgery did you have?

What type of anesthetic did you have?
--- choose one ---- General IV sedation Spinal Epidural Nerve block Other I don't remember

Who was your anesthesiologist?

Please rate your anesthesia experience:
1=strongly agree  2=somewhat agree  3=neutral or no opinion  4=somewhat disagree  5=disagree

My anesthesiologist was compassionate and listened to my concerns:
1strongly agree          2           3           4           5disagree

My anesthesiologist explained the type of anesthesia used:
1strongly agree          2           3           4           5disagree

My anesthesiologist answered my questions about the anesthesia:
1strongly agree          2           3           4           5disagree

I would recommend Longmont Anesthesia Associates to other patients:
1strongly agree          2           3           4           5disagree

Did you have any problems or concerns with your anesthetic?

Was your anesthetic a positive experience? Would you choose this type of anesthetic again?

Do you have any other comments about your entire surgical experience?

What is the most important thing your anesthesiologist can do to ensure your comfort, confidence and trust?

Was your anesthesiologist able to meet your needs?
--- choose one --- YES NO

Please click to send the information to us.