This study aimed to explore the family caregivers (FCs) perception of patients’ symptom burden as well as their experience and satisfaction with specialized palliative care services (PCS) in a tertiary care center in Kingdom of Saudi Arabia (KSA). Methods: A cross-sectional design assessed patients known to the PCS in a tertiary care center in Saudi Arabic from May 2023 to September 2023. FCs perceptions of patient’s symptom burden and satisfaction with PCS were studied through the Family Satisfaction with End-of-Life Care Scale (FAMCARE-2) and Arabic Questionnaire for Symptom Assessment (AQSA). Results: A convenience sample of 264 FCs agreed to participate (response rate = 94%). Approximately half of the participants were male (n=146; 55.7%). Participants were mostly aged between 30 to 50 years (n =148; 56%). Approximately half were receiving disease-modifying treatments. 101 (38.3%) had a Do-Not-Attempt-Resuscitation (DNAR) order. There was high satisfaction with how the services respected the dignity FCs (M = 4.6; SD=0.6). FCs were less satisfied with ‘the practical assistance provided by the PCS’ (M = 4.1; SD = 0.9). Satisfaction was higher in the outpatient setting (M = 4.3, SD = 0.7). The most severe symptom reported by FCs was ‘tiredness’, followed by ‘pain’. The mildest ones were ‘shortness of breath’, followed by ‘nausea/vomiting’. Conclusion: Overall, FCs have reported a positive experience with inpatient and outpatient PCS. FCs' greater satisfaction was observed in the outpatient setting with the possible rationale that inpatients are often more unstable and symptomatic.