RDV Sportsplex Pediatrics
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Forms Index 


Consent For Telemedicine Services
​Form
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click here

Please use an iPad or Tablet to sign this form

This form is used to obtain medical records to another office:
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* Health Information Release for 1 child

This form is used to send medical records to another office:
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Send Health Information Records to another office

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This form works best with the camera on a cell phone
New Insurance Card

Other Forms 

1 Month / 2 Month / 4 Month
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6 Month

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9 Month

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12 Month

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18 Month

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24 Month

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30 Month

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3 year

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4 year

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5 year

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6 year

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​Cardiac Risk Assessment

12 years and up

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Nurse's Visit
(Vaccines Only)

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Graded Concussion Symptom Checklist

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Return to Learn Protocol Form
Physician (MD/DO) Recommended School Accommodations Following Concussion Form

Phone # 407-916-4520
Fax # 407-916-4525
Email: admin@rdvpediatrics.com
8701 Maitland Summit Blvd., Orlando, Florida 32810
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Located at
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