Office Forms

New Patient Registration Form

Notice of Privacy Practices

Release of Records Request

Consent to the Use and Disclosure of Health information for Treatment

Credit Card Authorization

Office Policies


We see patients by appointment. If you have an urgent need and are an existing Archer Place Medical Clinic patient, we will accommodate you the same day whenever we can. If you are unable to keep a scheduled appointment we ask that you give us a 24 hour notice so that we may offer your time slot to another patient in needed. Multiple missed appointments without notification could result in charges.


Patients are responsible for any co-payments, deductibles and non-covered services at the time of visit. For your convenience, we accept cash, checks, debit and credit cards.


We participate with most major health insurance plans in the area. We recommend that you contact our office to confirm our participation with your plan.


When you need a prescription refilled, please contact our office at least 48 hours in advance. This gives the doctor time to review your file and authorize the refill. Please provide us with your pharmacy name, phone number and the name of the prescription you need refilled. Please note that, as a general rule, we do not refill medications after regular business hours including weekends.


We take patient privacy seriously. Click here to view our detailed HIPAA Privacy Policy. If you have any questions or concerns about our policy, please contact us.