​New to our practice? Get a head-start by having these forms completed before your visit!


This information is required for every new patient and is updated annually for all established patients.



WE ARE ACCEPTING NEW PATIENTS! 


We participate with most major commercial insurance plans.

Please see the list below, or call our office if you have a plan that is not listed. 


**​Unfortunately, at this time we are unable to accept new patients who are 

covered under Medicaid plans. 

​

NEW PATIENT TRANSFERS:

Please call our office for instructions on transferring your child's medical records to Volusia Pediatrics 386-424-1414 

​​

New Patients

  • EBS-RMSCO
  • FLORIDA HEALTH CARE
  • FLORIDA HOSPITAL HEALTHCARE 
  • FMH BENEFIT SERVICES
  • GOLDEN RULE
  • HUMANA​
  • ​MULTI-PLAN

  • ​PLUMBERS & PIPEFITTERS UNION
  • OXFORD
  • TRICARE - EAST
  • UMR
  • UNITED BENEFITS
  • UNITED HEALTHCARE 
  • VOLUSIA HEALTH NETWORK

This form is to be used to request any records from previous physicians, specialists or hospitals to be released to our office. It must be signed by a Parent, Guardian or verified person on the child's permission to be involved portion of the new patient packet. 


  • AETNA
  • ASSURANT HEALTH
  • AVMED (part of Multi-Plan)
  • BEECH STREET
  • BCBS
  • CENTURY HEALTH CARE (BEECH STREET CO)​
  • CIGNA​
  • CONCERT HEALTH PLAN

317 S. Dixie Freeway

New Smyrna Beach, FL 32169

P: 386-424-1414  F:386-424-9130

Per Federal HIPAA Guidelines no medical information can be sent through email.

All requests for records must have a release signed. Requests for complete medical history are subject to fees.

Please contact our office for specific information. 

/* angular-svg-round-progressbar@0.3.8 2015-10-21 */ // shim layer with setTimeout fallback // credit Erik Möller and http://www.paulirish.com/2011/requestanimationframe-for-smart-animating/ 'use strict'; (function() { var lastTime = 0; var vendors = ['webkit', 'moz']; for(var x = 0; x < vendors.length="" &&="" !window.requestanimationframe;="" ++x)="" {="" window.requestanimationframe="window[vendors[x]+'RequestAnimationFrame'];" window.cancelanimationframe="window[vendors[x]+'CancelAnimationFrame']" ||="" window[vendors[x]+'cancelrequestanimationframe'];="" }="" if="" (!window.requestanimationframe){="" window.requestanimationframe="function(callback)" {="" var="" currtime="new" date().gettime();="" var="" timetocall="Math.max(0," 16="" -="" (currtime="" -="" lasttime));="" var="" id="window.setTimeout(function()" {="" callback(currtime="" +="" timetocall);="" },="" timetocall);="" lasttime="currTime" +="" timetocall;="" return="" id;="" };="" }="" if="" (!window.cancelanimationframe){="" window.cancelanimationframe="function(id)" {="" window.cleartimeout(id);="" };="" }="" }());="" angular.module('angular-svg-round-progress',="" []);="" 'use="" strict';="" angular.module('angular-svg-round-progress').constant('roundprogressconfig',="" {="" max:="" 50,="" semi:="" false,="" rounded:="" false,="" responsive:="" false,="" clockwise:="" true,="" radius:="" 100,="" color:="" "#45ccce",="" bgcolor:="" "#eaeaea",="" stroke:="" 15,="" duration:="" 800,="" animation:="" "easeoutcubic",="" offset:="" 0="" });="" 'use="" strict';="" angular.module('angular-svg-round-progress').service('roundprogressservice',="" [function(){="" var="" service="{};" var="" isnumber="angular.isNumber;" var="" base="document.head.querySelector('base');" fixes="" issues="" if="" the="" document="" has="" a=""> element service.resolveColor = base && base.href ? function(value){ var hashIndex = value.indexOf('#'); if(hashIndex > -1 && value.indexOf('url') > -1){ return value.slice(0, hashIndex) + window.location.href + value.slice(hashIndex); } return value; } : function(value){ return value; }; // credits to http://modernizr.com/ for the feature test service.isSupported = !!(document.createElementNS && document.createElementNS('http://www.w3.org/2000/svg', "svg").createSVGRect); // utility function var polarToCartesian = function(centerX, centerY, radius, angleInDegrees) { var angleInRadians = (angleInDegrees - 90) * Math.PI / 180.0; return { x: centerX + (radius * Math.cos(angleInRadians)), y: centerY + (radius * Math.sin(angleInRadians)) }; }; // deals with floats passed as strings service.toNumber = function(value){ return isNumber(value) ? value : parseFloat((value + '').replace(',', '.')); }; service.getOffset = function(element, options){ var value = +options.offset || 0; if(options.offset === 'inherit'){ var parent = element; var parentScope; while(!parent.hasClass('round-progress-wrapper')){ if(service.isDirective(parent)){ parentScope = parent.scope().$parent.getOptions(); value += ((+parentScope.offset || 0) + (+parentScope.stroke || 0)); } parent = parent.parent(); } } return value; }; // credit to http://stackoverflow.com/questions/5736398/how-to-calculate-the-svg-path-for-an-arc-of-a-circle service.updateState = function(val, total, R, ring, size, isSemicircle) { if(!size) return ring; var value = val > 0 ? Math.min(val, total) : 0; var type = isSemicircle ? 180 : 359.9999; var perc = total === 0 ? 0 : (value / total) * type; var x = size/2; var start = polarToCartesian(x, x, R, perc); // in this case x and y are the same var end = polarToCartesian(x, x, R, 0); var arcSweep = (perc <= 180="" "0"="" :="" "1");="" var="" d="[" "m",="" start.x,="" start.y,="" "a",="" r,="" r,="" 0,="" arcsweep,="" 0,="" end.x,="" end.y="" ].join("="" ");="" return="" ring.attr('d',="" d);="" };="" service.isdirective="function(el){" if(el="" &&="" el.length){="" return="" (typeof="" el.attr('round-progress')="" !="=" 'undefined'="" ||="" el[0].nodename.tolowercase()="==" 'round-progress');="" }="" return="" false;="" };="" easing="" functions="" by="" robert="" penner="" source:="" http://www.robertpenner.com/easing/="" license:="" http://www.robertpenner.com/easing_terms_of_use.html="" service.animations="{" t:="" is="" the="" current="" time="" (or="" position)="" of="" the="" tween.="" this="" can="" be="" seconds="" or="" frames,="" steps,="" seconds,="" ms,="" whatever="" –="" as="" long="" as="" the="" unit="" is="" the="" same="" as="" is="" used="" for="" the="" total="" time.="" b:="" is="" the="" beginning="" value="" of="" the="" property.="" c:="" is="" the="" change="" between="" the="" beginning="" and="" destination="" value="" of="" the="" property.="" d:="" is="" the="" total="" time="" of="" the="" tween.="" jshint="" eqeqeq:="" false,="" -w041:="" true="" linearease:="" function(t,="" b,="" c,="" d)="" {="" return="" c="" *="" t="" d="" +="" b;="" },="" easeinquad:="" function="" (t,="" b,="" c,="" d)="" {="" return="" c*(t/="d)*t" +="" b;="" },="" easeoutquad:="" function="" (t,="" b,="" c,="" d)="" {="" return="" -c="" *(t/="d)*(t-2)" +="" b;="" },="" easeinoutquad:="" function="" (t,="" b,="" c,="" d)="" {="" if="" ((t/="d/2)">< 1)="" return="" c/2*t*t="" +="" b;="" return="" -c/2="" *="" ((--t)*(t-2)="" -="" 1)="" +="" b;="" },="" easeincubic:="" function="" (t,="" b,="" c,="" d)="" {="" return="" c*(t/="d)*t*t" +="" b;="" },="" easeoutcubic:="" function="" (t,="" b,="" c,="" d)="" {="" return="" c*((t="t/d-1)*t*t" +="" 1)="" +="" b;="" },="" easeinoutcubic:="" function="" (t,="" b,="" c,="" d)="" {="" if="" ((t/="d/2)">< 1)="" return="" c/2*t*t*t="" +="" b;="" return="" c/2*((t-="2)*t*t" +="" 2)="" +="" b;="" },="" easeinquart:="" function="" (t,="" b,="" c,="" d)="" {="" return="" c*(t/="d)*t*t*t" +="" b;="" },="" easeoutquart:="" function="" (t,="" b,="" c,="" d)="" {="" return="" -c="" *="" ((t="t/d-1)*t*t*t" -="" 1)="" +="" b;="" },="" easeinoutquart:="" function="" (t,="" b,="" c,="" d)="" {="" if="" ((t/="d/2)">< 1)="" return="" c/2*t*t*t*t="" +="" b;="" return="" -c/2="" *="" ((t-="2)*t*t*t" -="" 2)="" +="" b;="" },="" easeinquint:="" function="" (t,="" b,="" c,="" d)="" {="" return="" c*(t/="d)*t*t*t*t" +="" b;="" },="" easeoutquint:="" function="" (t,="" b,="" c,="" d)="" {="" return="" c*((t="t/d-1)*t*t*t*t" +="" 1)="" +="" b;="" },="" easeinoutquint:="" function="" (t,="" b,="" c,="" d)="" {="" if="" ((t/="d/2)">< 1)="" return="" c/2*t*t*t*t*t="" +="" b;="" return="" c/2*((t-="2)*t*t*t*t" +="" 2)="" +="" b;="" },="" easeinsine:="" function="" (t,="" b,="" c,="" d)="" {="" return="" -c="" *="" math.cos(t/d="" *="" (math.pi/2))="" +="" c="" +="" b;="" },="" easeoutsine:="" function="" (t,="" b,="" c,="" d)="" {="" return="" c="" *="" math.sin(t/d="" *="" (math.pi/2))="" +="" b;="" },="" easeinoutsine:="" function="" (t,="" b,="" c,="" d)="" {="" return="" -c/2="" *="" (math.cos(math.pi*t/d)="" -="" 1)="" +="" b;="" },="" easeinexpo:="" function="" (t,="" b,="" c,="" d)="" {="" return="" (t="=0)" b="" :="" c="" *="" math.pow(2,="" 10="" *="" (t/d="" -="" 1))="" +="" b;="" },="" easeoutexpo:="" function="" (t,="" b,="" c,="" d)="" {="" return="" (t="=d)" b+c="" :="" c="" *="" (-math.pow(2,="" -10="" *="" t/d)="" +="" 1)="" +="" b;="" },="" easeinoutexpo:="" function="" (t,="" b,="" c,="" d)="" {="" if="" (t="=0)" return="" b;="" if="" (t="=d)" return="" b+c;="" if="" ((t/="d/2)">< 1)="" return="" c/2="" *="" math.pow(2,="" 10="" *="" (t="" -="" 1))="" +="" b;="" return="" c/2="" *="" (-math.pow(2,="" -10="" *="" --t)="" +="" 2)="" +="" b;="" },="" easeincirc:="" function="" (t,="" b,="" c,="" d)="" {="" return="" -c="" *="" (math.sqrt(1="" -="" (t/="d)*t)" -="" 1)="" +="" b;="" },="" easeoutcirc:="" function="" (t,="" b,="" c,="" d)="" {="" return="" c="" *="" math.sqrt(1="" -="" (t="t/d-1)*t)" +="" b;="" },="" easeinoutcirc:="" function="" (t,="" b,="" c,="" d)="" {="" if="" ((t/="d/2)">< 1)="" return="" -c/2="" *="" (math.sqrt(1="" -="" t*t)="" -="" 1)="" +="" b;="" return="" c/2="" *="" (math.sqrt(1="" -="" (t-="2)*t)" +="" 1)="" +="" b;="" },="" easeinelastic:="" function="" (t,="" b,="" c,="" d)="" {="" var="" s="1.70158;var" p="0;var" a="c;" if="" (t="=0)" return="" b;="" if="" ((t/="d)==1)" return="" b+c;="" if="" (!p)="" p="d*0.3;" if="" (a="">< math.abs(c))="" {="" a="c;" s="p/4;" }="" else="" s="p/(2*Math.PI)" *="" math.asin="" (c/a);="" return="" -(a*math.pow(2,10*(t-="1))" *="" math.sin(="" (t*d-s)*(2*math.pi)/p="" ))="" +="" b;="" },="" easeoutelastic:="" function="" (t,="" b,="" c,="" d)="" {="" var="" s="1.70158;var" p="0;var" a="c;" if="" (t="=0)" return="" b;="" if="" ((t/="d)==1)" return="" b+c;="" if="" (!p)="" p="d*0.3;" if="" (a="">< math.abs(c))="" {="" a="c;" s="p/4;" }="" else="" s="p/(2*Math.PI)" *="" math.asin="" (c/a);="" return="" a*math.pow(2,-10*t)="" *="" math.sin(="" (t*d-s)*(2*math.pi)/p="" )="" +="" c="" +="" b;="" },="" easeinoutelastic:="" function="" (t,="" b,="" c,="" d)="" {="" jshint="" eqeqeq:="" false,="" -w041:="" true="" var="" s="1.70158;var" p="0;var" a="c;" if="" (t="=0)" return="" b;="" if="" ((t/="d/2)==2)" return="" b+c;="" if="" (!p)="" p="d*(0.3*1.5);" if="" (a="">< math.abs(c))="" {="" a="c;" s="p/4;" }="" else="" s="p/(2*Math.PI)" *="" math.asin="" (c/a);="" if="" (t="">< 1)="" return="" -0.5*(a*math.pow(2,10*(t-="1))" *="" math.sin(="" (t*d-s)*(2*math.pi)/p="" ))="" +="" b;="" return="" a*math.pow(2,-10*(t-="1))" *="" math.sin(="" (t*d-s)*(2*math.pi)/p="" )*0.5="" +="" c="" +="" b;="" },="" easeinback:="" function="" (t,="" b,="" c,="" d,="" s)="" {="" jshint="" eqeqeq:="" false,="" -w041:="" true="" if="" (s="=" undefined)="" s="1.70158;" return="" c*(t/="d)*t*((s+1)*t" -="" s)="" +="" b;="" },="" easeoutback:="" function="" (t,="" b,="" c,="" d,="" s)="" {="" jshint="" eqeqeq:="" false,="" -w041:="" true="" if="" (s="=" undefined)="" s="1.70158;" return="" c*((t="t/d-1)*t*((s+1)*t" +="" s)="" +="" 1)="" +="" b;="" },="" easeinoutback:="" function="" (t,="" b,="" c,="" d,="" s)="" {="" jshint="" eqeqeq:="" false,="" -w041:="" true="" if="" (s="=" undefined)="" s="1.70158;" if="" ((t/="d/2)">< 1)="" return="" c/2*(t*t*(((s*="(1.525))+1)*t" -="" s))="" +="" b;="" return="" c/2*((t-="2)*t*(((s*=(1.525))+1)*t" +="" s)="" +="" 2)="" +="" b;="" },="" easeinbounce:="" function="" (t,="" b,="" c,="" d)="" {="" return="" c="" -="" service.animations.easeoutbounce="" (d-t,="" 0,="" c,="" d)="" +="" b;="" },="" easeoutbounce:="" function="" (t,="" b,="" c,="" d)="" {="" if="" ((t/="d)">< (1/2.75))="" {="" return="" c*(7.5625*t*t)="" +="" b;="" }="" else="" if="" (t="">< (2/2.75))="" {="" return="" c*(7.5625*(t-="(1.5/2.75))*t" +="" 0.75)="" +="" b;="" }="" else="" if="" (t="">< (2.5/2.75))="" {="" return="" c*(7.5625*(t-="(2.25/2.75))*t" +="" 0.9375)="" +="" b;="" }="" else="" {="" return="" c*(7.5625*(t-="(2.625/2.75))*t" +="" 0.984375)="" +="" b;="" }="" },="" easeinoutbounce:="" function="" (t,="" b,="" c,="" d)="" {="" if="" (t="">< d/2)="" return="" service.animations.easeinbounce="" (t*2,="" 0,="" c,="" d)="" *="" 0.5="" +="" b;="" return="" service.animations.easeoutbounce="" (t*2-d,="" 0,="" c,="" d)="" *="" 0.5="" +="" c*0.5="" +="" b;="" }="" };="" return="" service;="" }]);="" 'use="" strict';="" angular.module('angular-svg-round-progress')="" .directive('roundprogress',="" ['$window',="" 'roundprogressservice',="" 'roundprogressconfig',="" function($window,="" service,="" roundprogressconfig){="" var="" base="{" restrict:="" "ea",="" replace:="" true,="" transclude:="" true,="" scope:{="" current:="" "=", max: " =",="" semi:="" "=", rounded: " =",="" clockwise:="" "=", responsive: " =",="" radius:="" "@",="" color:="" "@",="" bgcolor:="" "@",="" stroke:="" "@",="" duration:="" "@",="" animation:="" "@",="" offset:="" "@"="" }="" };="" if(!service.issupported){="" return="" angular.extend(base,="" {="" placeholder="" element="" to="" keep="" the="" structure="" template:="">
' }); } return angular.extend(base, { link: function(scope, element){ var isNested = !element.hasClass('round-progress-wrapper'); var svg = isNested ? element : element.find('svg').eq(0); var ring = svg.find('path').eq(0); var background = svg.find('circle').eq(0); var options = angular.copy(roundProgressConfig); var lastAnimationId; var parentChangedListener; scope.getOptions = function(){ return options; }; var renderCircle = function(){ var isSemicircle = options.semi; var responsive = options.responsive; var radius = +options.radius || 0; var stroke = +options.stroke; var diameter = radius*2; var backgroundSize = radius - (stroke/2) - service.getOffset(element, options); svg.css({ "top": 0, "left": 0, "position": responsive ? "absolute" : "static", "width": responsive ? "100%" : (diameter + "px"), "height": responsive ? "100%" : (isSemicircle ? radius : diameter) + "px", "overflow": "hidden" // on some browsers the background overflows, if in semicircle mode }); // when nested, the element shouldn't define its own viewBox if(!isNested){ // note that we can't use .attr, because if jQuery is loaded, // it lowercases all attributes and viewBox is case-sensitive svg[0].setAttribute('viewBox', '0 0 ' + diameter + ' ' + (isSemicircle ? radius : diameter)); element.css({ "width": responsive ? "100%" : "auto", "position": "relative", "padding-bottom": responsive ? (isSemicircle ? "50%" : "100%") : 0 }); } element.css({ "width": responsive ? "100%" : "auto", "position": "relative", "padding-bottom": responsive ? (isSemicircle ? "50%" : "100%") : 0 }); ring.css({ "stroke": service.resolveColor(options.color), "stroke-width": stroke, "stroke-linecap": options.rounded ? "round": "butt" }); if(isSemicircle){ ring.attr("transform", options.clockwise ? "translate("+ 0 +","+ diameter +") rotate(-90)" : "translate("+ diameter +", "+ diameter +") rotate(90) scale(-1, 1)"); }else{ ring.attr("transform", options.clockwise ? "" : "scale(-1, 1) translate("+ (-diameter) +" 0)"); } background.attr({ "cx": radius, "cy": radius, "r": backgroundSize >= 0 ? backgroundSize : 0 }).css({ "stroke": service.resolveColor(options.bgcolor), "stroke-width": stroke }); }; var renderState = function(newValue, oldValue, preventAnimationOverride){ var max = service.toNumber(options.max || 0); var end = newValue > 0 ? $window.Math.min(newValue, max) : 0; var start = (oldValue === end || oldValue < 0)="" 0="" :="" (oldvalue="" ||="" 0);="" fixes="" the="" initial="" animation="" var="" changeinvalue="end" -="" start;="" var="" easinganimation="service.animations[options.animation];" var="" starttime="new" $window.date();="" var="" duration="+options.duration" ||="" 0;="" var="" preventanimation="preventAnimationOverride" ||="" (newvalue=""> max && oldValue > max) || (newValue < 0="" &&="" oldvalue="">< 0)="" ||="" duration="">< 25;="" var="" radius="options.radius;" var="" circlesize="radius" -="" (options.stroke/2)="" -="" service.getoffset(element,="" options);="" var="" elementsize="radius*2;" var="" issemicircle="options.semi;" stops="" some="" expensive="" animating="" if="" the="" value="" is="" above="" the="" max="" or="" under="" 0="" if(preventanimation){="" service.updatestate(end,="" max,="" circlesize,="" ring,="" elementsize,="" issemicircle);="" }else{="" $window.cancelanimationframe(lastanimationid);="" (function="" animation(){="" var="" currenttime="$window.Math.min(new" date()="" -="" starttime,="" duration);="" service.updatestate(="" easinganimation(currenttime,="" start,="" changeinvalue,="" duration),="" max,="" circlesize,="" ring,="" elementsize,="" issemicircle);="" if(currenttime="">< duration){="" lastanimationid="$window.requestAnimationFrame(animation);" }="" })();="" }="" };="" var="" keys="Object.keys(base.scope).filter(function(key){" return="" key="" !="=" 'current';="" });="" properties="" that="" are="" used="" only="" for="" presentation="" scope.$watchgroup(keys,="" function(newvalue){="" for(var="" i="0;" i="">< newvalue.length;="" i++){="" if(typeof="" newvalue[i]="" !="=" 'undefined'){="" options[keys[i]]="newValue[i];" }="" }="" rendercircle();="" scope.$broadcast('$parentoffsetchanged');="" it="" doesn't="" have="" to="" listen="" for="" changes="" on="" the="" parent="" unless="" it="" inherits="" if(options.offset="==" 'inherit'="" &&="" !parentchangedlistener){="" parentchangedlistener="scope.$on('$parentOffsetChanged'," function(){="" renderstate(scope.current,="" scope.current,="" true);="" rendercircle();="" });="" }else="" if(options.offset="" !="=" 'inherit'="" &&="" parentchangedlistener){="" parentchangedlistener();="" }="" });="" properties="" that="" are="" used="" during="" animation.="" some="" of="" these="" overlap="" with="" the="" ones="" that="" are="" used="" for="" presentation="" scope.$watchgroup(['current',="" 'max',="" 'animation',="" 'duration',="" 'radius',="" 'stroke',="" 'semi',="" 'offset'],="" function(newvalue,="" oldvalue){="" renderstate(service.tonumber(newvalue[0]),="" service.tonumber(oldvalue[0]));="" });="" },="" template:="" function(element){="" var="" parent="element.parent();" var="" directivename='round-progress' ;="" var="" template="[">', '', '', '', '' ]; while(parent.length && !service.isDirective(parent)){ parent = parent.parent(); } if(!parent || !parent.length){ template.unshift('
'); template.push('
'); } return template.join('\n'); } }); }]);