West Volusia Family and Sports Medicine

Forms & Requests

We accept most insurance plans, however, it is the patient's responsibility to verify the providers participation with their individual plan. It is also the patient’s responsibility to make sure that Dr. John M. Hill is listed as your primary care provider on your insurance card even if you are seeing another provider in our office. This must be completed before we are able to schedule an appointment for insurance purposes. If the provider does not participate with their plan the patient will be responsible for the non covered charges. Our office is not accepting the affordable care act plans.

New Patients should use a personal computer to fill out the paperwork, using a phone to fill out these documents is not recommended and your information may be lost.

Click Here To Fill Out The New Patient Packet Online or

Click Here to download the new patient paper work (printable version)

Medical and Wellness services are provided by appointment only.

When calling our office for prescription refills, please allow 24-48 hours for processing. You can also have your pharmacist electronically fax an order for refills to our office at fax number (386) 774-0606, but this turnaround time can sometimes be longer than the 24-48 hour allotted time frame.

Please allow enough time for your prescriptions to be refilled. Medication refills will be filled at the time of your appointment and any pain management medication needed to be filled without an appointment is subject to be charged an administrative fee of $10. To avoid this please make sure to make your medical assistant aware of this at the time of your appointment. We ask that if you know you are running low on a medication to call our office a week prior to running out to give us the proper time to fill the prescription request.

We do charge a $25.00 no show fee for patients who schedule appointments and do not notify us within 24 hours of not being able to keep their appointment.

A charge of $25.00 is collected for all forms that need to be completed by the physician for other outside entities (example: disability parking permit form) if the forms are not done during a regularly scheduled appointment.

Our New Patient policy: Please come by our office for the new patient packet, fill out the new patient packet online, or download the new patient paper work on this site and complete fully and send to our office. Any packets not completely filled out will be returned until they are completed and will delay you ability to make an appointment. If any area of the packet is not applicable to you, please make sure to enter N/A. Once your new patient packet has been reviewed we will have our staff call and make your appointment.

Medical Records

Medical Record Requests

West Volusia Family and Sports Medicine respects the health information rights for our patients and has partnered with Provider1st to securely provide medical records to patients, guardian/legal representatives or 3rd party requestors with authorization. Please submit your medical record requests with proper authorization by email or fax listed below. If you have any questions or would like to check record status you can reach Provider1st by phone at: 855- 514-2378. Email: Requests@provider1st.com - Fax#: 800-818-2114. Note for Provider: make a blank MR request form available for requestors to download.

Patient MR Request Authorization Form (printable version)

Health Management Program (CCM)

Health Management Program (CCM) Form (printable version)

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