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

New Patient Forms

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

Option 1:

1. Fill out the PDF form below by typing in the PDF file directly or printing and filling it out by hand.
2. Submit your New Patient Paperwork to us via any of the following:
  • Email at admin@rdvpediatrics.com*
  • Fax to 407-916-4525
  • Bring a hard copy to your first appointment (be sure to arrive at least 15 mins early)
*If you decide to fill it out on your computer and submit via email, please save it to your computer and be sure it saves all of your information before sending it back to us!

Option 2:


Fill out and submit the forms via the the "online electronic" version link below and we will receive your information via our secure server.

New Patient Forms:

Or

Online Electronic Forms:

New Patient Forms
File Size: 787 kb
File Type: pdf
Download File

secure online forms

Submit a photo of your insurance card!
​(This form works best with the camera of a cell phone)
Picture
Insurance Card Photo Submission

(only for iPad and Tablet users)

* Health Information Release for 1 child
*If a Health Information Release is needed
​for more then 1 child click here

Patient Medical History

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

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