Patient Forms

Use this page to download patient follow up forms. All files are in Adobe Acrobat format. If you do not have the Adobe Acrobat reader, you can download it here.

Please choose the appropriate category to download the forms. Hip New, Hip Follow Up, Knee New,or Knee Follow-up. Then, print and fill them out manually.

Please FedEx the package to:

Evelyn Washington for new patients OR Keri Duval for follow up information
c/o Thomas P. Gross M.D.
Midlands Orthopaedics
1910 Blanding St.
Columbia, SC  29201

I.If you would like to be evaluated as a NEW PATIENT please click one of the following:

HIP                                KNEE

II.If you would like to complete a postoperative FOLLOW-UP evaluation, please click one of the following:

HIP                                KNEE

III. Patient Care Paths

1. Total hip arthroplasty care path
2. Total knee arthroplasty care path

IV. Hip Section:

A. New patient:

1. Your most recent x-rays (must be within the last 6 months; we prefer them on a disc), we do not need MRI films or CT scans
2. Patient Information Form
3. New patient hip questions
4. Medical history
5. Mission statement and disclosure
6. Privacy Information
7. Hip XR request
8. DEXA scan request; or your PCP can order this
9. CBC (complete blood count) request; or your PCP can order this
10. Copy of your insurance card: front and back
11. Please read Insurance information carefully

B. Follow-up patient:

1. Follow up hip questions
2. Mission statement and disclosure
3. Physical exam form
4. Physical therapy evaluation letter
5. Physical therapy evaluation request
6. Hip XR request

V. Knee Section

A. New patient:

1. Your most recent x-rays (must be within the last 6 months; we prefer them on a disc), we do not need MRI films or CT scans
2. Patient Information Form
3. New patient knee questions
4. Medical history
5. Mission statement and disclosure
6. Privacy information
7. Knee XR request
8. CBC (complete blood count) request; or your PCP can order this
9. Copy of your insurance card: front and back
10. Please read Insurance information carefully

B. Follow-up patient:

1. Follow up knee questions
2. Mission statement and disclosure
3. Physical exam form
4. Physical therapy evaluation letter
5. Physical therapy evaluation request
6. Knee XR request

VI. Surgical Risk Disclosure

1. Hip Resurfacing
2. Total Hip Arthroplasty
3. Total Knee Arthroplasty

VII.Others

1. Hospital discharge instructions
2. Phase I Hip exercise
3. Phase II hip exercises
4. Postoperative Knee exercises