Regenexx Candidate Form

Effective 9/01/2025, Middle GA Orthopaedics will have a new practice management/medical record system. Some delays are to be expected, and additional paperwork will be required. Please be patient while we are learning our new system. Thank you for trusting Middle GA Orthopaedics for your care. Team MGO.

Home » Regenexx » Regenexx Candidate Form

If you are suffering from a joint injury, osteoarthritis pain, back pain, or a non-healing fracture, you may be a candidate for Regenexx®. Please complete the Procedure Candidate Form below and we will get back to you with more information after your form is received.

Please note: Regenexx Procedures are not reimbursable by Healthcare or Medicare.

First Name(Required)

Last Name(Required)

Zip Code(Required)

Phone(Required)

Email(Required)

I am interested in treating my:(Required)

You can assist your Patient Liaison by providing additional information about your condition or surgical procedure you are wanting to avoid

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K. Scott Malone, M.D.

Jeffrey C. Easom, D.O.

William B. Wiley, M.D.

David H. Wiley, M.D.

Regenexx Candidate Form