Background <p>The primary purpose of this study was to determine whether unconscious racial and ethnic bias influences nonverbal rapport-building communication during the presurgical anesthesia consult.</p> Methods <p>A single academic center, observational study was conducted with enrollment of a balanced cohort of 102 White and minority group patients undergoing elective surgery in a level 1 trauma center and ambulatory surgery center between July 2021 and February 2022. This study was approved by the OHSU Institutional Review Board. Minority and White patients were matched by day of surgery and setting, trauma versus ambulatory center. Nonverbal communication (NSC) is a composite that takes into account different components of nonverbal behavior. These components are rated from 0 to 1 then added together to a final range of 0 (worst) to 4 (best). We examined (NCS) differences by minority status using a linear mixed-effects model with a random intercept to account for clustering by provider, adjusted for prespecified confounders of interest (provider minority status, sex, and experience level). Additional regression analyses assessed for post hoc confounding of NCS by patient health, surgical risk, and consult duration.</p> Results <p>NCS was not associated with American Society of Anesthesiologists physical status, surgical risk, or anesthesia consult duration. Multivariable analysis also found no significant association between patient minority status and NCS (coefficient estimate = − 0.07; 95% CI = [− 0.29,0.16]; <i>P</i> = 0.57).</p> Conclusions <p>In this study, unconscious racial and ethnic bias was not associated with NCS, change in baseline anxiety, or patient management decisions among anesthesia providers.</p> <p>Trial Registration</p> <p>Time stamped publicly available protocol available on clinicaltrials.gov: <a href="https://clinicaltrials.gov/study/NCT04508543">https://clinicaltrials.gov/study/NCT04508543</a></p>