Preparing for surgery requires the right paperwork, but finding the right medical clearance form online is often a struggle.
Many sites provide such forms, but they’re often hidden behind a paywall, require you to enter your email, or offer uneditable PDFs.
We solved this!
In this article, we’re sharing editable and customizable medical clearance forms for surgery, all designed in Google Docs.
You’ll get 8 unique templates, each with a color version and a black-and-white option, and they’re all completely free—no hidden fees or sign-ups.
Usage Note: These templates are free to use for both personal and commercial purposes. However, redistribution, resale, or uploading these templates to other websites or platforms for download or sale is strictly prohibited. Please respect the effort that went into creating these resources by using them responsibly.
General Medical Clearance Form for Surgery
This is a general medical clearance form for surgery which is suitable for most operations.
It covers all essential fields like your past health, physical check-up results, lab tests, medicines you take, allergies.
The physician can use this form to certify whether the patient is cleared for surgery or not.
General Medical Clearance Form for Surgery (B&W)
Medical Clearance Form for Dental Surgery
This medical clearance form is suitable just for dental surgeries.
With this form you can gather important patient details and health issues that might affect dental work.
We also provided special sections where the dentist can note things like infections, gum health, and cavities.
So if you are a dentist or someone who may need a clearance form for dental surgery you can use this to confirm if you are cleared or if you need more dental work before your procedure.
Medical Clearance Form for Dental Surgery (B&W)
Medical Clearance Form for Plastic Surgery
This form is made for plastic or cosmetic surgery patients.
It allows doctors to examine patients’ health conditions, medications they take, their lifestyle choices and any previous surgical procedures that might affect their operation.
The doctor’s sign-off confirms that both the patient and the surgeon are prepared for surgery.
Medical Clearance Form for Plastic Surgery (B&W)
Medical Clearance Form for Cataract Surgery
This form evaluates general health and eye health for people undergoing cataract surgery.
It includes sections on blood pressure readings and heart problems together with diabetes management and medication details.
The assessment confirms your physical readiness for an eye surgical procedure. Medical Clearance Form allows eye doctors and family doctors to communicate patient readiness for surgery smoothly.
Medical Clearance Form for Cataract Surgery (B&W)
Medical Clearance Form for Oral Surgery
This form is designed for patients needing oral and maxillofacial surgery who require dental evaluations alongside comprehensive health assessments.
It contains sections to examine mouth health conditions including infections and sores as well as gum health and a complete health history.
Your dentist or doctor can quickly determine whether you are cleared for surgery or require additional care.
Medical Clearance Form for Oral Surgery (B&W)
Pediatric Medical Clearance for Surgery Form
This pediatric clearance form is for children having surgery.
The form examines specific health concerns for children such as their developmental progress together with vaccinations, allergic reactions, and congenital conditions.
The pediatric clearance form enables pediatricians to record their evaluations and certify surgical readiness which protects young patients from anesthesia risks during surgery.
Pediatric Medical Clearance for Surgery Form (B&W)
VA Medical Clearance Form for Weight Loss Surgery
This form is specifically for veterans getting ready for weight loss or bariatric surgery.
It ensures veterans undergo a comprehensive medical check-up prior to the operation. The form contains sections which assess health issues connected to obesity including high blood pressure, diabetes, sleep apnea, and heart conditions.
Healthcare providers at VA facilities use this form to evaluate surgical readiness in veterans while identifying potential risks and verifying adherence to weight loss surgical program health requirements.
VA Medical Clearance Form for Weight Loss Surgery (B&W)
Dentist Medical Clearance Form for General Surgery
General surgeries occasionally require dental evaluations due to potential oral health issues that increase surgical risks.
This form allows dentists to evaluate and document oral health problems that might affect surgical outcomes which include infections and untreated dental issues as well as gum disease.
The dentist can confirm if any dental work is needed before you go ahead with medical or hospital surgeries.
Dentist Medical Clearance Form for General Surgery (B&W)
