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Jefferson Ambulatory Surgery Center

Jefferson Ambulatory Surgery Center
2701 Lake Villa Drive Suite B | Metairie, Louisiana 70002
phone: (504) 274-3100 | fax: (504) 274-3199

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  • The Center
    • Mission Statement
  • Forms and Instructions
    • General Pre-Op Instructions
    • Pain Management
  • Mako Robot
    • Physicians Using the Mako Robot
  • Your Day of Surgery
  • Contact Us

Forms and Instructions

Pre-Operative testing and registration must be completed at least 2-3 days prior to your surgery. An appointment is required for pre-operative testing, which can be scheduled Monday-Friday, between 7:30am-12:30pm.

Medical Forms

For your convenience, our medical forms are provided below. Please complete, sign, and bring the forms found in the links below as they pertain to the reason for your visit on the day of your pre-op appointment or for your pain management procedure.

We also request that you bring in your insurance card (not needed if through worker’s compensation) and a valid ID (driver’s license or state issued ID) with you to your pre-op appointment or for your pain management procedure.

  • Notice of Privacy Practice (HIPAA)
  • Patient Notification of Rights and Responsibilities
  • Advance Directives

Pre-Op/Surgery

Please visit Your Day of Surgery for more information pertaining to your pre-operative testing appointment

  • Patient Information Sheet
  • Anesthesia Questionnaire
  • Medication Reconciliation Form Pre-Op
  • General Pre-Op Instructions

Pain Management

Please visit the link below for more information pertaining to your pain management procedure.

  • Pain Management

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Jefferson Ambulatory Surgery Center

2701 Lake Villa Drive Suite B | Metairie, Louisiana 70002
phone: (504) 274-3100 | fax: (504) 274-3199
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