This packet is required for every new patient and annually for all established patients. It covers all the necessary information for our offices to provide your child's care to the best of our ability.
To make your child's transition to our practice as smooth as possible, we have provided the documents that you will need prior to your first appointment.
Please read over and then download all appropriate forms to fill out and fax or bring to our offices. Any questions or concerns that you may have can be answered by our caring staff.
Just call or email us through our contact page and we will be happy to help you through the process.
633 Dunlawton AVe.
Port Orange, FL 32127
P: 386-424-1414 F:386-424-9130
We are always accepting new patients here at Volusia Pediatrics
For new patients from out of state, our office will need to have all previous medical records
and immunization information before scheduling an appointment for your child
For your first appointment:
- Arrive 15 minutes early to check in.
- Provide your co-pay or co-insurance. They are due at the time of visit
- All new patients must be accompanied by their responsible party
- Provide a current State or Federal Identification Card (This is required at EVERY Appointment)
- All responsible parties must have each new patients insurance cards (This is required at EVERY Appointment)
Below is a list of accepted insurances within our practice*
New Patients
- EBS-RMSCO
- FIRST COAST ADVANTAGE
- FLORIDA MEDICAID
- FLORIDA HEALTH CARE
- FLORIDA HOSPITAL HEALTHCARE
- FLORIDA TRUE HEALTH
- FMH BENEFIT SERVICES
- GOLDEN RULE
- HEALTH SMART
- HUMANA
- MEDSAVE
- MULTI-PLAN
- PLUMBERS & PIPEFITTERS UNION
- OXFORD
- SUNSHINE STATE - MEDICAID
- TRICARE - SOUTH
- UMR
- UNITED BENEFITS
- UNITED HEALTHCARE - MEDICAID
- UNITED HEALTHCARE - Commercial
- 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 for your child's care. 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.
IF WE DO NOT HAVE PREVIOUS RECORDS PRIOR TO APPOINTMENTS - ALL SERVICES MIGHT NOT BE AVAILABLE
*Not all insurances are accepted at both locations. This list is subject to change without notice. Please check with the office directly to ensure coverage.
- AETNA
- AMERIGROUP
- ASSURANT HEALTH
- AVMED (part of Multi-Plan)
- BEECH STREET
- BCBS
- CENTURY HEALTH CARE (BEECH STREET CO)
- CHAMP VA
- CIGNA
- CONCERT HEALTH PLAN
317 S. Dixie Freeway
New Smyrna Beach, FL 32169
P: 386-424-1414 F:386-424-9130
Per Federal HIPPA Guidelines no medical information can be sent through email.
All requests for records must have a release signed. All requests for complete medical history are subject to fees.
Please contact our office for specific information.