Preoperative evaluation is a cornerstone of perioperative medicine, designed to identify modifiable risks, optimize patient health, and ensure safe surgical and anesthetic care. This chapter compares inpatient and outpatient models of preoperative evaluation, tracing their evolution from traditional hospital-based assessments to modern anesthesiologist-led outpatient and telemedicine models. It explores the clinical, operational, and economic implications of each setting, emphasizing the anesthesiologist’s expanding role as a perioperative consultant and leader in care coordination. Inpatient evaluations offer comprehensive access to diagnostics and multidisciplinary management for complex or urgent cases but are associated with higher costs and inefficiencies. Conversely, outpatient preanesthesia clinics (PACs) improve workflow efficiency, reduce surgical cancelations, shorten hospital stays, and minimize unnecessary testing—all while enhancing patient education and engagement. This chapter also highlights emerging innovations such as artificial intelligence, predictive analytics, and telemedicine, which are reshaping risk stratification, documentation, and patient communication. By contrasting the strengths and limitations of each model, this chapter underscores the need for anesthesiologists to lead data-driven, patient-centered preoperative care strategies that balance safety, access, and value in a rapidly evolving healthcare landscape.