RDV Sportsplex Pediatrics
  • Home
  • Our Office
    • Mission
    • Meet Our Providers
    • Meet Our Staff
    • Services Offered
    • Inside Tour
    • Top Doctors
    • Holiday Hours
    • Policies
    • Notice of Privacy Practices
  • New Patients
    • New Patient Forms
    • New Patient Appointment Request
    • Insurances Accepted
    • Prenatal/Meet-and-Greet RSVP
  • Existing Patients
    • Patient Portal
    • Referral List
    • Forms Index
    • Request/Send Us a Form
    • Records Request
    • Helpful Resources >
      • During Office Hours
      • After Office Hours
      • Family Resources
      • Common Forms and Handouts
      • Vaccines Video Series
      • Ages and Stages
  • Contact Us
    • Location
    • Send an E-mail
  • Billing
    • Bill Pay
    • Billing FAQ
  • Skin Care
    • Solutions
    • Before and After
    • Request a Consultation

Forms Index 


Consent For Telemedicine Services
​Form
Picture
click here

This form is used to obtain medical records from another office
​or 
to send medical records to another office:
Picture
Authorization for Release of Confidential Health Information

Picture
Send us a photo of your new insurance card!
​(This form works best with the camera on a cell phone)
New Insurance Card

This form is used to authorize RDV Sportplex Pediatrics to contact any individuals (including patient parents/legal guardians)
to deliver test results, gather additional information, or authorize care.

This form is also used for parents/legal guardians to authorize any additional indivuals to accompany their children to the office

for appointments and seek medical care and authorize treatment.
authorization for medical treatment
authorization for medical treatment (18 year olds and up)

Other Forms 

1 Month / 2 Month / 4 Month
Picture

6 Month

Picture

9 Month

Picture
Picture

12 Month

Picture

18 Month

Picture
Picture

24 Month

Picture

30 Month

Picture
Picture

3 year

Picture

4 year

Picture

5 year

Picture

6 year

Picture

​Cardiac Risk Assessment

12 years and up

Picture

Nurse's Visit
(Vaccines Only)

Picture

Graded Concussion Symptom Checklist

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

Documents Posted  GFE Office Notice   Notice of Privacy Practice   Poster Fees Medical Records
Phone # 407-916-4520
Fax # 407-916-4525
Email: admin@rdvpediatrics.com
8701 Maitland Summit Blvd., Orlando, Florida 32810
Facebook
Instagram
Visit Our ZO Skin Health Store

Located at
Picture
Design by DivTag Templates
UA-77455288-1