Client Registration Forms

covid-19 policy

To better serve the veterinary community we will be reinstating curbside services. Our goal is to reduce human foot traffic and prolonged person to person contact. We will miss our face to face interactions with our ongoing clients and look forward to having clients back in the building in the future.

ALL HUMANS ENTERING RESURGE MUST WEAR MASKS

Surgery Appointments
- Please call when you arrive and a Resurge staff member will guide you through the appointment process.
- Clients with initial surgical consults may enter the building to meet with our surgeon (1 person per animal patient).
- For all surgical rechecks and bandage change appointments we ask you to stay in your car.
- All discharges will be done over the phone unless special circumstances are needed.

Physical Rehabilitation
- Pease call when you arrive and a team member will guild you through the appointment process.
- Clients with initial rehab consult appointments (this includes 1 and 2 week post operative rehab suture/staple removal appointments) may enter the building (1 client per patient).
- On-going rehab appointments- only the pet may enter. Client should remain in their vehicle. Ongoing communication will be via phone call. If you wish to run an errand or leave, please make sure you communicate this to the staff member getting your pet or call the front desk.
- Payments will be taken over the phone or outside the building unless otherwise directed.

Medications
If your pet needs medication refills, please call us ahead of time and let us know. When you arrive, please call us so that we can bring your pet’s medications out to you. Payment can be made in the parking lot OT over the phone.

Please check *

I have read and understood the above COVID-19 Hospital Policy

Owner/Caregiver information

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Primary Contact Phone Number *

Secondary Phone Number *

Email *

Preferred form of communication *

Referring Veterinarian Name/ Hospital *

Referring Veterinarian Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Patient information

Pet's Name *

Breed *

Gender *

Age *

Date of birth *

Current problem with your pet *

Current Medications *

Known Allergies or Reactions to Drugs *

Duration of problem *

Your First Appointment *

Additional Comments about your pets condition *

Authorization Release

Resurge Veterinary Surgical Specialists and Rehabilitation LLC may use information from patients for purposes such as education and marketing materials. Examples: Continuing education and/ or social media.

Please choose one *

I DO Authorize I do NOT Authorize

use of my pet's first name, photograph and clinical information on the Resurge website, social media, or within informational pamphlets. Under no circumstances will my name, my personal or financial information be shared through these media sources.

Submit

covid-19 policy

Owner/Caregiver information

Patient information

Authorization Release

Home
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About
Contact
Blog
Client Registration Form
Veterinary Referral information

Contact Us
phone: 985-888-1059
email: resurge@resurge.vet

Location
641 River Highlands Blvd. Covington, LA 70433.

covid-19 policy

Owner/Caregiver information

Patient information

Authorization Release

HomeServicesAboutContactBlogClient Registration Form​Veterinary Referral information

Contact Usphone: 985-888-1059email: resurge@resurge.vet

Location641 River Highlands Blvd. Covington, LA 70433.

Home
Services
About
Contact
Blog
Client Registration Form
Veterinary Referral information

Contact Us
phone: 985-888-1059
email: resurge@resurge.vet

Location
641 River Highlands Blvd. Covington, LA 70433.