Phone: (541) 472-0603 | 702 SW Ramsey Ave. Suite 112 | Grants Pass, OR 97527

Patient Forms

Here you can access the doctor-specific forms to help you further understand your orthopedic concerns and answer your post-operative questions.

 

Items Patients Need to bring to first visit
– Patient forms completely filled out:
–¬†Patient Information
–¬†Medication List
– Any previous X-rays or imaging studies
– Insurance information/cards
– Payment/Co-payment

Downloadable Patient Forms:
(Click on a link below to download, print, fill out and bring into the office)
Notice of Patient Privacy
Patient Information
Medical History Form
Cast Care Instructions
Financial Policy
Medication List
Family HIPPA Authorization
Exercise Reconciliation Sheet

Total Hip Replacement Forms:

Treatment of Knee and Hip Arthritis (Part I)
Treatment of Knee and Hip Arthritis (Part II)
Treatment of Hip Arthritis (Part III) – Anterior Hip Replacement
Treatment of Hip Arthritis (Part III) – Posterior Hip Replacement
Treatment of Hip Arthritis (Part III) – Revision Total Hip Replacement

Pre-Op Infection Precautions – Bactroban MSSA
Total Joint Replacement Going Home

Paragon Orthopaedic Bowel Program
Day of Surgery Instructions
Total Joint Replacement Medication Things to Do
Patient Wound Instructions – Hip

Home Instructions: Revision Hip Replacements
4 Weeks after Revision Hip Replacement
8 Weeks after Revision Hip Replacement

Home Instructions: Anterior Approach Hip Replacements
4 Weeks after Anterior Hip Replacement
8 Weeks after Anterior Hip Replacement

Home Instructions: Posterior Approach Hip Replacements
4 Weeks after Posterior Hip Replacement
8 Weeks after Posterior Hip Replacement

Total Knee Replacement Forms:
Treatment of Knee and Hip Arthritis (Part I)
Treatment of Knee and Hip Arthritis (Part II)
Treatment of Knee Arthritis (Part III)

Pre-Op Infection Precautions – Bactroban MSSA
Total Joint Replacement Going Home

Paragon Orthopaedic Bowel Program
Day of Surgery Instructions
Total Joint Replacement Medication Things to Do
Patient Incision Care Instructions – Knee

Home instructions after Total Knee Replacement
8 Weeks after Total Knee Replacement

Dr. Bents Post Surgery Info:
Arthroscopic Post Operative Surgery Guidelines
Postoperative Knee Arthroscopy instructions
Shoulder arthroscopy instructions
Cast Care Instructions

 

Financial & Insurance Information
We are committed to you and your medical care. It is our sincere desire to assist you with the financial aspect of your medical care. The fees you are charged varies with the complexity of your problem and the length of time required to manage your condition. You may incur charges for physician fees, x-rays, cast work and special procedures.

We deliver the finest care at the most reasonable cost to our patients; therefore, payment is due at the time of service unless prior arrangements have been made. As a courtesy, we will bill most primary and secondary insurance companies. We accept all major credit cards. Please remember you are fully responsible for all fees charged by this office regardless of your insurance coverage. If you have questions regarding your account, please contact us at (541) 244-2153. Many times, a simple telephone call will clear any misunderstandings.

After Hours Emergency Care
A physician is available for emergency calls 24 hours a day. The answering service will forward all messages to the physician on call. In the event of a life threatening emergency, please call 911 or go directly to the emergency room. Please note that no prescriptions will be refilled after hours.

Prescription fills
Please contact your pharmacy directly for prescription refills. They have all the information needed and will contact our office. Prescriptions will be refilled Monday through Thursday during normal business hours. Please do not wait until you are out of medication to contact your pharmacy. No prescriptions will be refilled after hours or on weekends.

Disability/Insurance Forms
Disability or insurance forms can be prepared in our office. While we try to complete these as soon as possible, it may take up to 10 (ten) days to complete these forms. There will be a $15.00 charge for each form completed to be paid at the time the form is presented.

Medical Records/X-rays
Your medical record (including x-rays) is kept strictly confidential. Except as specified in our Notice of Privacy Practices, we will not release your information without your written consent. Should you wish your records or x-rays be sent to another party, please contact our office. Please allow time for preparation and mailing.

Surgical Scheduling
If surgery has been recommended, our office will be contacting you. Many insurance companies require prior authorization prior to scheduling surgery. It is important what we have accurate insurance information from you. Our office will work with you to coordinate all appointments and insurance requirements. If you have any questions regarding your surgery, prior authorization, or pre-surgical appointments, please contact us.

Post-Op Information
# Generic Post-Op
# Post-Op Knee Arthroscopy
# Post-Op Shoulder Arthroscopy
# Shoulder Replacement Surgery for Shoulder Arthritis
# Arthroscopic SLAP Repair Protocol
# Arthroscopic Rotator Cuff Repair Protocol

Casts
Casts should fit snugly but not too tight. There may be skin discomfort around the hand/foot but should not become raw or painful. Please call our office if you have any questions about your cast.

Please click here for our Cast Care Instructions.