PLEASE READ THE FOLLOWING INSTRUCTIONS BEFORE PROCEEDING TO THE FORMS BELOW:
1. Use this page to download new patient and 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.
2a. For new in-state patients, please schedule an initial office visit so that Dr. Gross can evaluate your joint. IN-STATE PATIENTS MUST BE SEEN IN THE OFFICE TO SEE IF THEY ARE A CANDIDATE FOR SURGERY. All intial forms will be available in our office, but in order to keep your visit brief, we recommend printing and completing the new patient packet before coming in.
Once complete, please FedEx the package to:
Thomas P. Gross M.D.
Midlands Orthopaedics, P.A.
1910 Blanding St.
Columbia, SC 29201
New Patient Forms
OUT-OF-STATE PATIENTS: When all information is submitted, Evelyn will send the completed file to Dr. Gross for review. Usually, he will be able to call you within 3 weeks of receiving your information. Please be alert to calls from a blocked phone number or from any phone # with an 803 area code because Dr. Gross will call from home, the office, or the hospital.
I. For initial evaluation (choose one):
II. Information needed to schedule surgery:
- Mission Statement and Disclosure Form
- Privacy Information Form
- Financial Policy Form
- CBC Request (your PCP can order this)
- Please read through Insurance Information carefully
- Authorization and Acknowledgement Form
- HIPAA Privacy and Authorization Form
*Section II forms (not necessary for intial evaluation) ARE REQUIRED PRIOR TO SCHEDULING SURGERY.