---
title: Surgical Medical Clearance and Consent Form Template | Paperform
description: Professional pre-operative surgical clearance form template with consent authorization, testing requirements, medication management, NPO instructions, and anesthesia consultation scheduling.
url: "https://paperform.co/templates/surgical-medical-clearance-and-consent-form"
type: static
generatedAt: "2026-03-28T00:45:18.924Z"
---

[← Back to free form templates](/templates/)    ![Surgical Medical Clearance and Consent Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/surgical-medical-clearance-and-consent-form.png)
    [Preview](https://_preview.paperform.co/ai-template/surgical-medical-clearance-and-consent-form) [Use this template for free](/create?ai-template=surgical-medical-clearance-and-consent-form)    [Healthcare & Medical Forms](/templates/category/healthcare/)[Legal & Compliance Forms](/templates/category/legal/) [Healthcare](/templates/industry/healthcare/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
### Streamline Surgical Clearance with a Professional Medical Consent Form

Preparing patients for surgery involves coordinating multiple pre-operative requirements—medical history reviews, testing orders, medication adjustments, NPO instructions, and anesthesia consultations. This **Surgical Medical Clearance and Consent Form** template brings all these critical elements into one organized, professional form that ensures nothing falls through the cracks.

Built specifically for surgical centers, hospitals, and healthcare providers, this template helps you collect comprehensive patient information, document informed consent, and manage pre-operative protocols efficiently. With conditional logic built in, the form adapts based on patient responses, showing relevant follow-up questions and instructions only when needed.

#### Perfect for healthcare teams who need to:

 - **Obtain informed consent** for surgical procedures with clear documentation
 - **Coordinate pre-operative testing** including labs, imaging, and cardiac evaluations
 - **Manage medication adjustments** and ensure patients follow NPO guidelines
 - **Schedule anesthesia consultations** and collect relevant medical history
 - **Maintain HIPAA compliance** with secure data collection and storage

#### Automate your surgical clearance workflow

Connect this form to **Stepper** (stepper.io) to automate your entire pre-operative workflow. Trigger tasks like scheduling pre-op appointments, sending reminder emails for NPO instructions, notifying the anesthesia team of consultations, and updating your EMR system—all without manual data entry.

Need patient signatures on consent documents? Use **Papersign** (papersign.com) to automatically generate surgical consent forms and HIPAA authorizations from submission data, then collect legally binding eSignatures to complete your medical records.

Paperform is SOC 2 Type II certified and designed for healthcare providers who need secure, professional forms that integrate seamlessly with existing systems. While this platform is not HIPAA compliant, it provides robust security features suitable for many healthcare administrative workflows. For HIPAA-covered workflows, consider implementing additional safeguards or consulting with your compliance team.

This template saves time for surgical coordinators, pre-operative nurses, and administrative staff while ensuring patients receive clear instructions and proper preparation for their procedures.
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