Patient satisfaction survey
Please feel free to complete this form if I have anaesthetised you or your child. It helps me to ensure I am providing good quality service and identifies areas upon which I can improve.

This is an anonymous survey.

1. Were you satisfied with your anaesthetic?
Unsatisfied
Very satisfied
2. Did you feel you were well informed about the commonly experienced side effects of anaesthetic?
Poorly informed
Very well informed
3. Were you satisfied with your pain management?
Unsatisfied
Very satisfied
Please provide any further information that you may find further explains any difficulties you experienced
Your answer
4. Would you recommend my services to a friend or family member?
5. Is there something I could have done better to improve your experience?
Your answer
6. Is there something else you would like to tell me about?
Your answer
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