Dr. Gross’ Forms
New Patient Instructions
PLEASE READ THE FOLLOWING INSTRUCTIONS CAREFULLY BEFORE PROCEEDING.
New In-State Patients
If you are a new in-state patient, Dr. Gross prefers to evaluate you in the office to see if you are a candidate for surgery. Please schedule an initial office visit by calling us at (803) 256-4107. Please submit all Initial Evaluation materials before your first visit. Review the packet in its entirety, using the first page as a checklist. If you are a new patient and would like assistance with preparing or submitting your new patient package, please contact Evelyn at (803) 933-6170 or email at evelyn.washington@midorthoneuro.com.
New Out-of-State Patients
If you are a new out-of-state patient (or unable to come to our office), we will need ALL the materials from the new patient packet under Initial Evaluation. PRINT, FILL OUT, AND MAIL IN. Review the packet in its entirety, using the first page as a checklist.
If you would like to have a telephone consultation with Dr. Gross or need help putting together your new patient package, please contact Evelyn at (803) 933-6170 or email at evelyn.washington@midorthoneuro.com.
Once complete, please FedEx the package to:
Thomas P. Gross M.D.
Midlands Orthopaedics & Neurosurgery, P.A.
1910 Blanding St.
Columbia, SC 29201
New Patient Forms
Initial Evaluation
There are two ways to complete your New Patient Package. You may download the new patient packages and submit via mail/email or you may go through the online submission process (if available). All download files are in Adobe Acrobat format. If you do not have the Adobe Acrobat reader, you can download it here.
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Dr. Gross Ortho Treatments
Hip Resurfacing
Metal-On-Metal Hip Resurfacing
Columbia Hip Protocol
Total Hip Replacement
Pre-Op Patient Instructions
PLEASE READ THE FOLLOWING INSTRUCTIONS CAREFULLY BEFORE PROCEEDING.
The forms below are for after you have completed an initial evaluation. THEY ARE REQUIRED BEFORE SCHEDULING SURGERY. If you would like assistance with preparing or submitting these forms, please contact Evelyn at (803) 933-6170 or email at evelyn.washington@midorthoneuro.com.
Pre-Op Forms
There are two ways to complete your Pre-op Forms. You may download the forms and submit via mail/email or you may go through the online submission process (if available). All download files are in Adobe Acrobat format. If you do not have the Adobe Acrobat reader, you can download it here.
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For All Patients
- Mission Statement and Disclosure Form
- Please read our Notice of Privacy Practices
- CBC Request (Your PCP can order this.)
- Read through the Insurance Information section carefully.
Hip
Surgical Risk Disclosure
Knee
Follow-up Instructions
PLEASE READ THE FOLLOWING INSTRUCTIONS CAREFULLY BEFORE PROCEEDING.
We request postoperative follow-up at 6 weeks (4 weeks for knees), 3 months (knees only), 1 year, 2 years, and every 2 years thereafter. You can schedule an in-office visit for each of these intervals by calling (803) 256-4107, or you can complete a remote follow-up.
For a postoperative follow-up evaluation, you will need to complete the appropriate follow-up package and mail it to us along with your x-rays. If you have difficulties with this, please call Sherri at 803-933-6101 or email us at grosspatientfollowup@midorthoneuro.com.
Remote Follow-ups
For remote follow-ups, please download the appropriate follow-up package AND READ THROUGH THE INSTRUCTIONS CAREFULLY. PRINT, FILL OUT, AND MAIL IN. Review the packet in its entirety, using the first page as a checklist.
We require the following materials for your remote follow-up:
- 6 weeks (2-4 week knees) – questionnaire, physical exam, x-rays and mission statement disclosure form
- 3 months (knees only) – questionnaire, physical exam and x-rays
- 1 year – questionnaire, physical exam and x-rays
- 2 year hips – questionnaire, physical exam, x-rays and metal ion test
- 2 year knees – questionnaire, physical exam and x-rays
- >2 years – questionnaire and x-rays
Once complete, please FedEx the package to:
Thomas P. Gross M.D.
Midlands Orthopaedics & Neurosurgery, P.A.
1910 Blanding St.
Columbia, SC 29201
Follow-up Forms
There are two ways to complete your Follow-up Package. You may download the follow-up packages and submit via mail/email or you may go through the online submission process (if available). All download files are in Adobe Acrobat format. If you do not have the Adobe Acrobat reader, you can download it here.
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Hip
Follow-Up Packages
Please choose your closest postoperative interval.
Knee
Follow-Up Packages
Please choose your closest postoperative interval.
Additional Forms
PLEASE READ THE FOLLOWING INSTRUCTIONS CAREFULLY BEFORE PROCEEDING.
The forms below are available for your convenience. All download files are in Adobe Acrobat format. If you do not have the Adobe Acrobat reader, you can download it here.
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For All Patients
Hip
- Phase I Hip Exercises
- Phase II Hip Exercises