Patient Resources and Patient Portal

Our patient resources and patient portal make it convenient for you to securely access your patient records, pay your bill and fill out patient forms online.

Patient Portal

To sign up for your patient portal to securely access your medical records, please click on your providers’ corresponding link below:

Archbold Ear, Nose, Throat and Allergy Center
Archbold Gastroenterology Group
Archbold Neurology Group
Archbold Neurosurgery Services
Archbold Northside Center for Behavioral and Psychiatric Care
Archbold Primary Care
Archbold Pulmonary Medicine and Critical Care Services
Cairo Internal Medicine
Camilla Pediatric Center
Cardiolovascular Consultants of South Georgia, LLC
Lewis Hall Singletary Oncology Center
Medical Group of Mitchell County
Pelham Primary Care
South Georgia Surgical Associates
Urology Associates of Archbold
Vascular Interventional of Thomasville Assoc.

Online Bill Pay

Online bill pay coming soon! Check back for more updates!

Patient Forms

You can now conveniently access our patient forms online! The links below allow you to access the forms needed for your upcoming appointment as well as print and fill them out from the comfort of your home. Please bring the completed forms with you to your appointment.

The forms are categorized by physician practice below.

Archbold Ear, Nose, Throat and Allergy Center
AMG 116-Archbold Medical Group Patient Information
AMG 116-Archbold Medical Group Patient Information (Spanish)
AMG 167-Patient History Questionnaire
MR 332- Summary of Joint Notice Privacy Practices
MR 332- Summary of Joint Notice Privacy Practices (Spanish)
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information (Spanish)


Archbold Gastroenterology Group
AMG 116-Archbold Medical Group Patient Information
AMG 116-Archbold Medical Group Patient Information (Spanish)
AMG 179-Medicare Secondary Payer Questionnaire
MR 332- Summary of Joint Notice Privacy Practices
MR 332- Summary of Joint Notice Privacy Practices (Spanish)
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information (Spanish)


Archbold Neurology Group
AMG 116-Archbold Medical Group Patient Information
AMG 116-Archbold Medical Group Patient Information (Spanish)
AMG 179-Medicare Secondary Payer Questionnaire
MR 332- Summary of Joint Notice Privacy Practices
MR 332- Summary of Joint Notice Privacy Practices (Spanish)
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information (Spanish)
ADMT 110-Assignment of Benefits
ADMT 110-Assignment of Benefits (Spanish)


Archbold Neurosurgery Services
AMG 116-Archbold Medical Group Patient Information
AMG 116-Archbold Medical Group Patient Information (Spanish)
AMG 132-Patient History
MR 332- Summary of Joint Notice Privacy Practices
MR 332- Summary of Joint Notice Privacy Practices (Spanish)
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information (Spanish)
ADMT 110-Assignment of Benefits
ADMT 110-Assignment of Benefits (Spanish)

Archbold Primary Care
AMG 116-Archbold Medical Group Patient Information
AMG 116-Archbold Medical Group Patient Information (Spanish)
AMG 168-Controlled Substance Verification
AMG 177-Obligation to Pay for Physician Professional Services
AMG 179-Medicare Secondary Payer Questionnaire
AMG 183-New Patient Application
MR 332- Summary of Joint Notice Privacy Practices
MR 332- Summary of Joint Notice Privacy Practices (Spanish)
MR107-Authorization for Use and Disclosure of Protected Health Information
MR107-Authorization for Use and Disclosure of Protected Health Information (Spanish)
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information (Spanish)
ADMT 110-Assignment of Benefits
ADMT 110-Assignment of Benefits (Spanish)

Archbold Pulmonary Medicine and Critical Care Services
AMG 116-Archbold Medical Group Patient Information
AMG 116-Archbold Medical Group Patient Information (Spanish)
AMG 166-Comprehensive History and Physical for All New Patients
MR 332- Summary of Joint Notice Privacy Practices
MR 332- Summary of Joint Notice Privacy Practices (Spanish)
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information (Spanish)
ADMT 110-Assignment of Benefits
ADMT 110-Assignment of Benefits (Spanish)


Cairo Internal Medicine
AMG 116-Archbold Medical Group Patient Information
AMG 116-Archbold Medical Group Patient Information (Spanish)
AMG 144-Patient History
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information (Spanish)
ADMT 110-Assignment of Benefits
ADMT 110-Assignment of Benefits (Spanish)
AMG 179-Medicare Secondary Payer Questionnaire


Camilla Pediatric Center
AMG 151-Patient Information
AMG 152-Pediatric Patient History
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information (Spanish)
ADMT 110-Assignment of Benefits
ADMT 110-Assignment of Benefits (Spanish)
MR 332- Summary of Joint Notice Privacy Practices
MR 332- Summary of Joint Notice Privacy Practices (Spanish)
MR107-Authorization for Use and Disclosure of Protected Health Information
MR107-Authorization for Use and Disclosure of Protected Health Information (Spanish)

Medical Group of Mitchell County
AMG 116-Archbold Medical Group Patient Information
AMG 116-Archbold Medical Group Patient Information (Spanish)
AMG 179-Medicare Secondary Payer Questionnaire
AMG 153-Patient History
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information (Spanish)
ADMT 110-Assignment of Benefits
ADMT 110-Assignment of Benefits (Spanish)
MR 332- Summary of Joint Notice Privacy Practices
MR 332- Summary of Joint Notice Privacy Practices (Spanish)
MR107-Authorization for Use and Disclosure of Protected Health Information
MR107-Authorization for Use and Disclosure of Protected Health Information (Spanish)

Pelham Primary Care
AMG 116-Archbold Medical Group Patient Information
AMG 116-Archbold Medical Group Patient Information (Spanish)
AMG 179-Medicare Secondary Payer Questionnaire
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information (Spanish)
ADMT 110-Assignment of Benefits
ADMT 110-Assignment of Benefits (Spanish)
MR 332- Summary of Joint Notice Privacy Practices
MR 332- Summary of Joint Notice Privacy Practices (Spanish)
MR107-Authorization for Use and Disclosure of Protected Health Information
MR107-Authorization for Use and Disclosure of Protected Health Information (Spanish)


South Georgia Surgical Associates
AMG 116-Archbold Medical Group Patient Information
AMG 116-Archbold Medical Group Patient Information (Spanish)
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information (Spanish)
ADMT 110-Assignment of Benefits
ADMT 110-Assignment of Benefits (Spanish)
MR 332- Summary of Joint Notice Privacy Practices
MR 332- Summary of Joint Notice Privacy Practices (Spanish)


Urology Associates of Archbold
AMG 116-Archbold Medical Group Patient Information
AMG 116-Archbold Medical Group Patient Information (Spanish)
AMG 104-Patient History
AMG 172-Review of Systems
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information
ADMT 126-Consent for Common Treatment and Use/Disclosure of Patient Medical Information (Spanish)
ADMT 110-Assignment of Benefits
ADMT 110-Assignment of Benefits (Spanish)
MR 332- Summary of Joint Notice Privacy Practices
MR 332- Summary of Joint Notice Privacy Practices (Spanish)