Patient Forms


The staff of The Surgical Clinic has assembled a collection of the most commonly requested forms. These forms are often needed by a patient’s school, employer, insurance company or by supplemental insurance companies such as AFLAC. It is very important that you find out from those entities whether any of these forms might be required to excuse your absence or apply for insurance, disability or workers’ comp in Tennessee.

By clicking on the links, you will be able to access any of the forms that you might need. There are two ways to fill out each form:

1. You may download the form and print it from your computer/printer. From there you can fill out the needed information and bring it with you to the office at your next scheduled visit.

2. Most of the forms are enabled so that you can type your answers into the form from your computer. To do this, you will need to download the form to your computer before you start to fill in your responses. From there, you can save the filled out form on your computer and send it via email back to the office or print it and bring it along to your next scheduled appointment.

While copies of all of these forms are also available in your surgeon’s office, we urge you to fill your part out on each form you need before you see your doctor. Please plan to come in early in order to fill out the paperwork if you are requesting copies of the forms from the office. If there are forms you have that you need a physician signature for, we ask that you have the form before your exam with your part of the form filled out. This way you are often able to leave your appointment with the form(s) you need.

You may access your account thorough the patient portal at any time.

welcome new patients

Get a head start on your paperwork. Please print and fill out each of the forms below and bring them with you to your doctor when you visit. 

Referring Physicians


The Surgical Clinic (TSC) has over 40 board certified surgeons throughout Middle Tennessee that offer advanced treatments and surgical care with a patient-centered focus. Thank you for trusting TSC with your patient’s needs.

Dr. Goers’ Patients

Dr. Goers’ has provided patients with information that can be viewed and printed to best help you prepare for your surgery (preoperative) and healthiest lifestyle after surgery (postoperative).

Resources + forms

The Surgical Clinic wants to ensure that you receive the resources you need before and after your surgery. Please view, download or print any of the information below and let us know if you have any questions. Thank you for choosing TSC!

Coronavirus (COVID-19) update: click here.