You are invited to participate in this research study conducted at the Mediclinic Parkview Hospital Dubai, UAE. Please, take your time to read the following information carefully, before you decide whether you wish to take part in this research study or not.

You are encouraged to ask the Principal investigator if you need any additional information or clarification about what is stated in this form and/or in the research study as a whole.

Purpose of the Research Study and Overview of Participation

Measuring patient satisfaction has become an important parameter of the continuous quality assessment and improvement in anaesthesia services.

The purpose of this study is to assess patient satisfaction with peri-operative care and determine the factors influencing patient satisfaction at Mediclinic Parkview hospital, Dubai.

Patient satisfaction is an important component of quality of care delivered and influences recovery process. Enhancing the quality of service improves the satisfaction of patients.

The data collected will help us determine the critical factors that most impact patients’ satisfaction with their peri-operative anaesthetic care.

This will help improve our quality of care by adopting a more patient centered approach.

If you agree to take part in the study, you will be issued an electronic questionnaire that will be collecting data on the following topics:

  • Patient demographics
  • General questions regarding your medical procedure
  • Information received from your anaesthesia team
  • Patient needs and discomfort
  • Impression of the anaesthesia team

If you do not wish to participate in the study, your care will not be affected in any way, you will simply not be asked to complete the questionnaire.

Any Risks as a Result of Participating in the Study

The study does not pose any foreseeable risks to you. Your information will be kept confidential, and any personal or identifying information will be removed from the collected data prior to analyzing and publishing the results.

Any Benefits as a Result of Participating in the Study

The results of the questionnaire will be used to establish a higher standard of peri- operative anaesthetic care that is more patient centered.

All results positive or negative will be valuable when considering future appropriate approaches to developing an exceptional standard of care.

Any Alternative Treatment

If you do not wish to participate in the study, your care will not be affected in any way, you will simply not be asked to answer the questionnaire.

If you agree to take part in this research study, please, be ensured that the obtained information will be kept confidential. Unless required by law, only the study investigator or designee, the MBRU-Institutional Review Board (MBRU-IRB), DHA, Mediclinic,

and/or inspectors from governmental agencies will have direct access to your information.

In case of any adverse event, as a result of the study, there will be no compensation to cover such expenses if it is not covered by a third party or governmental insurance.

I have read and understood all aspects of the research study and all my questions have been answered.

I voluntarily agree to be a part of this research study and I know that I can contact Dr. Indira Kannan or any of her team involved in the study in case I have any questions.

If I feel that my questions have not been answered, I can contact the MBRU-IRB, DHA, and/or Mediclinic Parkview.

I understand that I am free to withdraw this consent and discontinue participation in this project at any time, even after signing this form, and it will not affect my care or benefits.

Patient satisfaction survey on Perioperative Anesthesia Services at Mediclinic Parkview Hospital, Dubai.

We would like to know how you feel about the anesthesia services provided at Mediclinic Parkview Hospital, Dubai to ensure we meet your needs. Your responses will be kept strictly confidential and anonymous. Please dedicate a few minutes of your time to answer the questions included about your experience with the anesthetic department.

* Required


The following questions will focus on your background. Please select the choice that best applies to you.

General questions about your medical procedure

The following questions will be help us know more about your stay at the hospital. Please answer them to the best of your knowledge.

Information received from the anesthesia team

The next series of questions will ask you about the information you received from anesthesia team during your visit.
Please indicate the extent of your agreement or disagreement by picking one of options you will be given.

Discomfort and needs

The next series of questions will aim to understand how the anesthesia team fulfilled your requirements regarding discomfort and pain management post operatively. Please choose the answer you feel is most appropriate.

Impression of the anesthesia team

These last set of questions will be regarding your personal experience with the anesthetic department that handled your care. Please choose the answer you feel is most appropriate with respect to your experience.

This field is required.
Please add the two figures together (spam protection)