Southern Surgical Group

Please fill out the form below and a member of our staff will contact you to set up a time for your visit.   First Name Last Name  Phone Number Address City State Zip Code Email Referring Doctor Please provide us with your preferred time so our staff can review our schedule prior to contacting you to set up your office visit.

Information When seeing new patients, we need some information to begin. If you are a new patient, download a copy of each of the forms below and fill them out prior to your visit. Mail the completed forms to our office or bring them with you to your appointment. Completing the forms prior to your visit can help us get you in to see our doctors sooner during your visit. Mailing Address: Southern Surgical Group 2728 Sunset Blvd, Suite 403 West Columbia, SC 29169   Patient Forms The following forms are provided in Adobe Acrobat PDF format. Download Adobe Acrobat Reader if you do not already have it. Instructions to Patients Payments, Co-payments & Deductibles Patient Information Form Patient Medication Record Patient Medical History Authorization for Release of Information