Internal Medicine Associates of John's Creek, Inc. - Samantha B. Benson, MD

Please review the following terms and conditions:

Internal Medicine Associates offers a patient portal log on to every patient of the practice. This allows patients to access their records online anytime. The portal will allow you to

*See and print your Lab Results
*Perform online medication refills
*Make Appointments
* Ask your provider medical related questions

Our office strives very hard to provide the best service we possibly can coupled with the latest technology to provide you the information you need to communicate with our office.

This technology is very costly, and we are asking our patients who choose to have access to the patient portal to share in this cost as part of an annual fee.

We believe this fee is a minimal amount and will allow us to keep this service in place for those patients who would like to have access to their records online.

Thank you for choosing Internal Medicine Associates of Johns Creek, and we appreciate your business.

The TERMS:

Please digitally sign and click below to accept the terms above and agree to pay the
$25.00 annual fee (calendar year). I accept my account being billed this fee and will pay upon receiving ONE statement. If payment is not received within 30 days of invoicing, my log on information will expire immediately but will be emailed to me once payment has been received.

Full Name:

E-mail address:

By filling out your full name and email address and clicking on "I agree", this will be considered your digital signature and stating that you agree to the terms and conditions of this policy.