Background: The Pre Anesthetic Check Up (PAC) is a vital component of perioperative care, aimed at preparing patients for anesthesia and subsequent surgery by assessing their medical history, physical condition, and potential risks. Despite its importance, there is a significant gap in patient awareness and knowledge of PAC, particularly in regions with challenging geographic and demographic factors like Chamba, Himachal Pradesh. This study assesses the level of awareness and knowledge regarding PAC among patients scheduled for surgery at Pt Jawahar Lal Nehru Government Medical College, Chamba. Material & Methods: A descriptive, cross-sectional survey was conducted from January to May 2024 among 400 patients scheduled for surgery at Pt Jawahar Lal Nehru Government Medical College, Chamba. Data were collected using a pre-tested Google form questionnaire focusing on socio-demographic characteristics and knowledge of PAC. The questionnaire included 20 structured knowledge-related questions, scored to categorize participants into four knowledge levels. Data were analyzed using Epi Info V7 Software, focusing on frequencies and percentages. Results: The majority of participants (74%) were less than 40 years old, with a slight male predominance (55%). Most participants were married (55%), and the educational background varied, with 30% having at least secondary education and 25% having higher secondary education. Awareness of PAC was moderate, with 70% having heard of it, 60% knowing its purpose, and 50% understanding its components. However, only 40% were aware of preoperative fasting guidelines. Knowledge scores revealed that 20% had Very Good knowledge, 30% had Good knowledge, 25% had Fair knowledge, and 25% had Poor knowledge. The main barriers to understanding PAC included lack of information from healthcare providers (40%), limited access to educational materials (30%), low health literacy (20%), and language barriers (10%). Conclusion: This study highlights significant gaps in patient education regarding PAC, with many patients demonstrating suboptimal knowledge. Key barriers include insufficient information from healthcare providers, limited access to educational materials, low health literacy, and language barriers. Targeted interventions such as accessible educational materials, preoperative counseling, and educational campaigns are needed to improve patient understanding of PAC, ensuring better preparedness and perioperative outcomes.