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Surveys
2016
March
A
Anaesthesia Survival Form
Anaesthesia Survival Form
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After your operation I would like to invite you to provide me with a feedback about your anaesthetic experience. Your answers give me the opportunity to optimise my anaesthetic service. I appreciate your help.
How satisfied are you with your anaesthetic experience?
Extremely Unsatisfied
Unsatisfied
Neutral
Satisfied
Extremely Satisfied
How satisfied are you with the pre-anaesthetic assessment?
Extremely Unsatisfied
Unsatisfied
Neutral
Satisfied
Extremely Satisfied
How satisfied are you with the management of your anxiety?
Extremely Unsatisfied
Unsatisfied
Neutral
Satisfied
Extremely Satisfied
How satisfied are you with the management of your pain?
Extremely Unsatisfied
Unsatisfied
Neutral
Satisfied
Extremely Satisfied
How did you feel BEFORE your operation?
Fine
in pain
anxious
How did you feel AFTER your operation?
well
anxious
cold
in pain
nauseated
Other
How can your anaesthetist improve your anaesthetic experience?
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