RDV Sportsplex Pediatrics
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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.


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


Option 1 (Online Version):

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

Online Electronic Forms (English):

secure online forms

Online Electronic Forms (Spanish):

secure online forms (EspaƱol)

Option 2 (Fill Out by Hand & Submit Via Email/Fax/In-person):

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!

New Patient Forms:

new_pt_forms.pdf
File Size: 670 kb
File Type: pdf
Download File


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

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
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