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Tennessee SS-3023 Physician's Statement for Absentee

Tennessee voters who are medically unable to vote in person can be placed on the permanent absentee list, so the county election commission sends them an absentee ballot application for each election. SS-3023 is the one-page licensed physician's statement, made under Tennessee Code Annotated section 2-6-201(3)(A), that supports that status. It is attached to the voter's permanent registration record.

Who completes it

The voter's licensed physician completes and signs the whole statement: the patient's name, date of birth, Social Security number and address, the cause and duration of the condition, and the physician's signature, printed name, address and phone. The voter requests ballots on Tennessee's separate Absentee By-Mail Ballot Application.

Submitting and payment

How to submit it
The signed statement is filed with the election commission of the voter's county at least 10 days before the election.
Who pays
The form sets no fee for the physician's statement.

Good to know

  • The physician certifies the voter cannot appear at the polling place or at the election commission office for early voting because of sickness, hospitalization or physical disability, and checks which applies.
  • The physician marks the condition as perpetual or temporary; for a temporary condition the form asks for an estimated date of recovery.
  • The statement is signed under penalty of perjury and is attached to the voter's permanent registration record. The current version is Rev. 02/12.
  • Voters who simply cite illness or disability to vote absentee in one election use the Absentee By-Mail Ballot Application (Rev. 10-2025) and do not need SS-3023.

Get the official form

Download the current version from the source each time; forms change without notice.

Physician's Statement

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

See how Vero Documents works

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Who can sign Tennessee's SS-3023 Physician's Statement?

The voter's licensed physician. The physician certifies, in their professional medical judgment, that the patient is medically unable to go to the polling place or the election commission office for early voting because of sickness, hospitalization or physical disability, and signs under penalty of perjury.

When is the Tennessee physician's statement for absentee voting due?

The Secretary of State says it must be filed not less than 10 days before the election. Once it is on file with the county election commission, the voter receives an application for an absentee ballot for each election instead of requesting one every time.

Does SS-3023 work for a temporary illness?

The form lets the physician mark the sickness, hospitalization or physical disability as perpetual or temporary, and asks for an estimated recovery date when it is temporary. Voters who only need an absentee ballot for one election can cite illness on the regular absentee application instead.