Background for this research is the result of observation conducted by the researcher from 10 July until 10 October 2017 at the PKU Muhammadiyah Hospital Yogyakarta that shows common preoperative patient experiencing a mental shock such as fear and excessive worry resulting in anxiety. The aim of this study is to know the rationale for the formation of the special section in Islamic Spiritual Care Service in PKU Muhammadiyah Hospital for surgical patients. This research also aims to : (1) know the factors causing preoperative patient to experience anxiety; (2) know the strategy of Islamic Spiritual Care to overcome preoperative patient's anxiety in PKU Muhammadiyah Hospital Yogyakarta; (3) to know the benefit of Islamic Spiritual Care for preoperative patient; (4) To know the constraints of Islamic Spiritual Care faced in dealing with preoperative patient anxiety. This research method is qualitative research method. Techniques of collecting data in this research are observation, interview, and documentation. The results of the research show that: (1) Special section of Islamic Spiritual Care for preoperative patients with anxiety formed because this function are needed to entrusted to the spiritual officer who has the criteria of being able to build communication well and interesting, able to bring peace to the preoperative patient, and also has many experience in giving service to many patient so that spiritual officer can develop capabilities to help prevent and solve problem faced by patient (2) Most preoperative patient experience anxiety feel uncomfortable, fear, hesitate and worried about ugliness after operation. The anxiety is caused by lack of experience to hospitalized, afraid of the surgery room, and fear of surgery result failure. (3) Strategies of Islamic spiritual care in handling preoperative patient are niat (recite good intention), assessment of patient background, motivate, pray, and non-verbal strategies. (4) The patient's response to spiritual guidance services tends to positive. (5) obstacles faced by the provider of Islamic spiritual care service tend to come from the patient themselves such as. patient rejection due to their lack of knowledge about the function of Islamic spiritual services.