RDV Sportsplex Pediatrics
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Become a New Patient​



We are currently accepting new patients into our practice. Availability for new-patient appointments may be limited so that we can continue to provide our active patients with the extra time and accessibility that makes our office special. Thank you for considering us for your child’s care.
​

Please arrive 25 minutes prior to your scheduled appointment to ensure your registration is complete before meeting with your new provider.

Register Your Newborn


​Expecting parents who want to establish care for their child after birth can register their newborn with his/her due date at any time. We encourage parents that would like to register to schedule and come to a MEET & GREET in the office. Some months the number of new patients may be limited to first-time parents due to a large number of younger siblings being born to established families.

To make sure there are no delays:

Remember to bring:
  • Your insurance card
  • Valid photo ID
  • List of current medications
  • Office co-pay
In an effort to respect the time of all of patients, our staff strives to stay on schedule so that other patients do not have to wait.
For patients who are delayed and arrive late for appointment, every effort will be made to see them the same day. However, wait times may apply, or appointments may need to be rescheduled.

Patient Forms

English

​HIPAA AUTHORIZATION TO RELEASE PATIENT INFORMATION  
Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility. 

Spanish

​AUTORIZACIÓN DE HIPAA PARA DIVULGAR INFORMACIÓN DEL PACIENTE  
Permite a los pacientes autorizar la divulgación de su información médica a un individuo, compañía, agencia o centro designado.​

​Authorization and Consent to Treatment  -
All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. 

​Preferred Contacts  
Patients are encouraged to complete and return the Preferred Contacts Form but it is not required.


​AUTORIZACIÓN Y CONSENTIMIENTO PARA TRATAMIENTO
Todos los pacientes deben dar su consentimiento para el tratamiento, las comunicaciones (llamadas, correos electrónicos y mensajes de texto) y la aceptación de la responsabilidad financiera.

​Contactos preferidos
Se anima a los pacientes a completar y devolver el Formulario de Contactos Preferidos, pero no es obligatorio.


​Virtual Visit Technology Policy
​
This policy describes the process for the documentation, maintenance, and transmission of information using virtual visit technology.

Office Policies

English

Spanish

​FINANCIAL POLICY  
This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations. 
Notice of Privacy Practices   
​
Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully​
POLÍTICA FINANCIERA  
Este formulario notifica a los pacientes sobre su completa responsabilidad financiera por todos los servicios médicos recibidos, independientemente de la elegibilidad del seguro o las determinaciones de cobertura.
Aviso de prácticas de privacidad 
​
Describe cómo la información de salud sobre usted (como paciente de este Centro de Atención) puede ser usada y divulgada, y cómo puede acceder a su información de salud individualmente identificable. Por favor, revise este aviso cuidadosamente.


​

Language Services

Link

Warning: A doctor-patient relationship is not establish by submitting forms.
We can only consider you as a patient after the first appointment.


Please note: We at RDV follow the American Academy of Pediatrics standards
​regarding vaccinations and do not accept patients that do not vaccinate.


We do understand some parents would like to limit the number of vaccines given during one appointment, and we could arrange for an alternative schedule, but most insurances will not cover the extra appointment needed. Please let your provider know about your intentions and she will explain how we can accomplish this with no major consequences.  


​Notice of Nondiscrimination
​Press Room
Notification of Privacy Practice
​Prospective Doctors

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Phone # 407-916-4520
Fax # 407-916-4525
Email: [email protected]
8701 Maitland Summit Blvd., Orlando, Florida 32810
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