Serving your local Florida communities! Including but not limited to: Ormond Beach, Daytona Beach, Port Orange and Palm Coast.

Request to Join Pediatrics On Call

Request to Join Pediatrics On CallSkye2023-10-04T16:06:15-04:00

Please complete this request to join and we will send you patient intake forms via our Electronic Health Records system to complete your membership activation and get your medical kit on its way to you!

**Membership is $15.99/mo for one child or $19.99/mo for more than one child (from the same family) and a one-time registration fee per family of $100 (+ tax and shipping) which includes your medical kit with a digital otoscope for examining the ears, a digital thermometer, and a pulse oximeter. There is also an option for an iPhone compatible otoscope for an additional $10+tax.

Email us at pediatricsoncall247@gmail.com with any questions!

Request to Join Pediatrics On Call

Email(Required)

Child 1

Patient #1 Name (First, Middle, Last)(Required)

First Middle Last

Patient #1 Date of Birth (mm/dd/yyyy)(Required)

(0-18 years of age only please)

Patient #1 Gender(Required)

Male

Female

Add a second child?

Yes

Child 2

Patient #2 Name (First, Middle, Last)(Required)

First Middle Last

Patient #2 Date of Birth (mm/dd/yyyy)(Required)

(0-18 years of age only please)

Patient #2 Gender(Required)

Male

Female

Add a third child?

Yes

Child 3

Patient #3 Name (First, Middle, Last)(Required)

First Middle Last

Patient #3 Date of Birth (mm/dd/yyyy)(Required)

(0-18 years of age only please)

Patient #3 Gender(Required)

Male

Female

Add a fourth child?

Yes

Child 4

Patient #4 Name (First, Middle, Last)(Required)

First Middle Last

Patient #4 Date of Birth (mm/dd/yyyy)(Required)

(0-18 years of age only please)

Patient #4 Gender(Required)

Male

Female

Add a fifth child?

Yes

Child 5

Patient #5 Name (First, Middle, Last)(Required)

First Middle Last

Patient #5 Date of Birth (mm/dd/yyyy)(Required)

(0-18 years of age only please)

Patient #5 Gender(Required)

Male

Female

Add a sixth child?

Yes

Child 6

Patient #6 Name (First, Middle, Last)(Required)

First Middle Last

Patient #6 Date of Birth (mm/dd/yyyy)(Required)

(0-18 years of age only please)

Patient #6 Gender(Required)

Male

Female

Primary Pediatrician

Primary Pediatrician Name(Required)

First Last

Primary Pediatrician Address(Required)

Street Address Address Line 2 City State ZIP Code

Primary Pediatrician Phone(Required)

Contact Information

Parent/Guardian Names and Relation to Child(ren)(Required)

Name

Relation to Child

(List only those authorized to make health care decisions for the child)

Residential Address (MUST reside in Florida)(Required)

Street Address Address Line 2 City State ZIP Code

Mailing Address (Where you want your medical kit shipped)(Required)

Street Address Address Line 2 City State ZIP Code

Best Cell Phone Number for Telehealth Phone and Video Visits and Contact Number(Required)

Payment Information

Breakdown and pricing below reflects your ONE-TIME registration fee (including your medical kit) with taxes and shipping where applicable. The total cost at the end of the form will be charged to your credit card.

Registration

Price:

Digital Thermometer

Price:

Includes tax

Pulse Oximeter

Price:

Includes tax

Digital Otoscope(Required)

iPhone Compatible Otoscope ($48.39)

Standard Otoscope (35.04)

Includes tax and shipping within costs

Total

Name(Required)

First Last

Credit Card

Get help now!

Ever wonder whether to keep your child home from school or cancel a family event because they feel sick? Having at-home tests on hand means you’ll get quick answers — and can take quick action if necessary!

Fever or flu? Sore throat or strep?

With at-home tests, you can know before you go!

Click the button below to order the tests and we will ship them to you so you have them on hand when you need them. If you need a test today, please call us prior to placing your order to make arrangements for pick up.

Current Members – Order Tests!

Request to Join Pediatrics On Call

Request to Join Pediatrics On Call

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

Primary Pediatrician

Contact Information

Payment Information

Get help now!

Fever or flu? Sore throat or strep?

Expert Pediatric Care, Where You Are, When You Need It