Sunshine Pediatrics

Sunshine Pediatrics of Central Florida, PL
Richard Rodriguez, MD (a.k.a. Dr. Rich)
210 Lookout Place
Maitland, FL 32751
Phone 407-215-0400
Fax 407-215-0402
"The doctor kids love and parents trust"

Office Policies & Forms

Adobe Acrobat Reader® is required to view the following forms. To download this free software, click here.
If transferring in from another pediatric practice,
we MUST have vaccine records and growth charts before first well visits)  
All NEW Patients who are seen for the FIRST TIME in our office must fill out these forms and fax or e-mail them to our office.

 Or, come 40 minutes before your appointment time with completed forms to allow for data to be entered into electronic records.
FAX  to  407-215-0402
Mail to Sunshine Pediatrics, 210 Lookout Place, Maitland, FL 32751
Or, bring completed forms to 1st visit 20 minutes before appointment time to allow for data to be entered into electronic records.
Please read our Privacy Practices
TRANSFERING IN TO OUR OFFICE FROM ANOTHER OFFICE - Complete and fax or mail this form to your child's previous pediatrician to request your child's records to be released to us.  Please note that most pediatricians charge the patient for this service.  You might want to call them to inquire as to their policy.
to your previous pediatrician
If transferring in from another pediatric practice, we MUST have vaccine records
and growth charts before first well visits)
TRANSFERING OUT OF OUR OFFICE TO ANOTHER OFFICE - If you wish your child's records transferred to another pediatric practice. Please complete this form and fax or mail to our office.  A fee for copies may apply.
FAX  to  407-215-0402
Mail to Sunshine Pediatrics, 210 Lookout Place, Maitland, FL 32751
If you wish for someone other than the parent or legal guardian to bring your child to the office to be seen for a visit, please complete this consent form and have it notarized.  This includes grandparents and step parents.
(requires notarized signature of legal parent)
FAX  to  407-215-0402
Mail to Sunshine Pediatrics, 210 Lookout Place, Maitland, FL 32751
Or, bring at time of visit.
If you wish to do another vaccine schedule or choose not to vaccinate your child(ren), you will be required to sign our vaccine policy as well as AAP Refusal to Vaccinate. If you are planning to following the AAP/CDC recommended vaccine schedule you do not need to sign this policy.

If your child needs Sports Physical forms completed, please complete and bring this form with you at time of visit along with any school required forms.

Complete and bring at time of visit.
If you need HRS forms completed for school or day care programs, they must be requested at time of visit.  If your child is seen by the physician and the forms are requested at a later date a fee for completing the forms will be charged.

We have the HRS forms available,
but it is your responsibility to request the forms
at time of visit.
CLICK HERE to read office policy regarding forms.


We strive to streamline and help families to have as pleasant and as efficient communication and care with our office and our patients as possible. In an effort to save you time, we have provided several patient forms to help you prepare for your office visit below in Adobe Acrobat Reader®. Forms are above, scroll up. Please print the appropriate form(s) out for your upcoming visit and complete the form(s). It will save you time if you can fax or mail the completed form(s) before your first visit.  If you have to bring the forms at time of visit, please arrive 30 minutes before scheduled time to allow time for data from the forms to be entered into our electronic records system. If you are in doubt as to which form(s) you will need, please call or e-mail our office staff and they will be happy to assist you.

Your child must be accompanied by a parent or legal guardian to be seen or treated in our office.  If you must have a relative or other person bring your child for a visit, we require a notarized form giving us the parent/guardian's permission for medical services to be presented at time of visit or to be on file in your child's electronic record. Forms are above, scroll up.

Please remember to also bring your child's most current insurance card to ensure the information (group number, provider number, etc.) is valid at the time of service. Your insurance card is similar to a credit card. The information must be valid in order for it to be used. If we do not have the most up-to-date insurance information, it makes it difficult to process claims.  You will be asked to see your insurance card at every visit.  We will need to verify your child's eligibility prior to every visit, however, if we are unable to do so, you will be required to pay for the visit at the time of service.  Co-pays and any unpaid balance will be collected at check-in before your visit.

Age Policy
Sunshine Pediatrics will begin seeing your child as a newborn. We will continue to see your child until the child completes their last year of high school, including their pre-college exam. At that point, we ask that you transfer their records to a Physician specializing in Adult Care.

Appointment Policies

Sunshine Pediatrics sees patients on an appointment only basis. We do NOT offer Walk-In Visits, if you walk in without an appointment there will be an out-of-pocket charge of $35.00. We do reserve same day appointments for sick children. During regular office hours, if your child is ill and needs to be seen, we appreciate your calling in advance in order that we may see patients most efficiently. During high peak cold/flu season (approximately between mid-November and early March) the waits tend to be longer due to the higher volume of sick visits.

Hospital Births-If you are a parent of a Newborn, please call the office as soon as possible after being discharged from the hospital to make your baby's first checkups. We like to see your newborn at 3-5 days of age if you had a hospital birth.  If you have a newborn boy who you choose to have circumcised, we prefer to circumcise your son on that 3-5 day visit.  Please inform us when you schedule the appointment that you wish to have the circumcision done at that time so we can appropriately schedule enough time for the procedure.
Home or Birth Center Births-If you had a home or birth center birth, please call the office in a few hours after the birth to schedule for the baby to be seen within 24 hours of birth. If baby is born on a Saturday afternoon or Sunday, and there is a concern, please call our office and the telephone system will give you instructions which will route you to the voicemail of the on-call provider and you will be called back then call first thing Monday morning and we will see your baby same day.

WELL CHILD Checkup Schedules
We follow the recommendations of the American Academy of Pediatrics well child checkup schedule. These are the ages that we typically do checkups.

Newborn (3-5 days hospital births; 24 hours after birth if home birth or birth center birth)
2 week
2 month
4 month
6 month
9 month
12 month
15 month
18 month
Annual checkups for ages 2 years and up
We encourage parents to schedule next appointment at check-out immediately before or after each of the above visits, up to the 2 year well.

For all Well Child Annual Check-ups following the 2 year check-up, we recommend you call us at least 2-3 months in advance to schedule their annual physical in order for us to best accommodate you with your schedule.

Also, it's important to call to schedule well check-ups, ADHD/ADD, and MED-CHECKs 2-3 months before time needed to help us best accommodate your schedule.

After Hours Availability
After hour calls, dial the office number and you will receive a different message. Follow the instructions on the message, you'll be ask to leave a brief message and your phone number (PLEASE REPEAT the phone number TWICE).  Either Dr. Rich or a Nurse Practitioner will call you back.

Note we do not prescribe medications or give refills over the phone. If you feel that your child needs to be examined by a physician when our office is closed, we advise you to go to one of the following:

Night Lite Pediatrics and Nemours Children's Urgent Care open about 5:00 PM to 11:00 PM weekdays and also have Saturday and Sunday hours.  We advise using their services when they are open as your child will be seen quicker than most Emergency Rooms in the Central Florida area and they will be seen by a pediatrician not an adult physician.

If your child needs to be seen between 12:00 midnight and our opening office hours, your only choice is to be seen in a hospital Emergency Room.  We advise you to call our regular phone number during these hours to speak with the doctor, if you have questions regarding the need to go to the Emergency Room.  ALWAYS call 911 if your child is having serious breathing problems (turning blue) or has a serious accident.

Cancellation Policy
Missed appointments for routine/preventive well care are very disruptive to our office and deprive others from an appointment to be seen. Twenty-four (24) hour cancellation notification is required to avoid the $35.00 no-show fee.

Financial Policy
The following is a statement of our Financial Policy, which we require you to read and sign prior to treatment.

Due to frequent changes in health insurance coverage, we require that you provide proof of insurance coverage at each visit. If you do not have insurance, are unable to provide proof of insurance coverage, or are on a plan in which we do not participate, full payment is required at the time of your visit.

All co-payments are due at the time of service. These fees cannot be waived. All co-pays not collected at the time of service will incur a $5 billing fee. Please be aware that some services provided may be non-covered services and not reimbursable by your insurance. You are personally responsible for these services. For your convenience we accept cash, check, Visa/Master Card (including debit cards), American Express and Discover.

If we are a participating provider, we will file your insurance for each visit. Should there be a dispute with your insurance company, our insurance department will attempt to resolve it for you as a courtesy. During this time, the balance may be transferred to your responsibility. Please note that your insurance policy is a contract between you and your insurance company, therefore, your balance is your responsibility.

Missed appointments for routine/preventive care are very disruptive to our office and deprive others from an appointment to see the doctor. Twenty-four (24) hour cancellation for routine check-ups is required to avoid the $35 charge.

Financial arrangements for large balances can be made through our payment program. Failure to resolve any past due accounts, including returned checks will result in referral to a collection agency. Any family whose account is forwarded to a collection agency will be dismissed from our practice.

Record Transfers
When requesting your child(ren)'s medical record to be transferred to another physicians office, please be advised that the required time needed to complete your request is 2 business days. In the event you are requesting copies of the medical records yourself, there will be a  fee per child in accordance with Florida Statute.  We will make every effort to complete your request in the shortest time possible. Requests for transfer of medical records will incur an administrative fee of $10 per child up to two and $30 for 3 or more children. An immunization record can be provided at no charge for active patients.

Policy Regarding Forms
We have placed our office forms in PDF on this site for your convenience and to help expedite services. Feel free to print any of those off and complete them in full. You may fax or mail these or other form requests.
Fax: 407-214-0402  Address: Sunshine Pediatrics, 210 Lookout Place, Maitland, FL 32751

Request for Immunization & Camp Forms (Sport Physical Forms)
Immunization forms for daycare and/or school can be requested at the time of routine well child visits at NO CHARGE.  It is your responsibility to make your request for the forms when the nurse is working your child up for their well child visit.

IF you request an immunization form for your child(ren)'s school or daycare by phone or at a sick visit there will be an administrative fee of $5.00.  We require 72 business hours to complete the forms.  "Rush" forms incur an administrative fee of $10.00.

Camp or sports physical forms requested at times other than a routine well visit will also require an administration fee of $5.00 with a 72-hour notice or $10.00 for “rush” forms.  These forms will be dated with the date of the last well child visit which must be at least within the year, however, some schools require that the physical be done closer to the time of the event or sport season.  It is your responsibility to check with your child's program to see how close to the event or sport season they require the physical.  If your child requires another separate physical, you will need to schedule an appointment for a “sport physical” at a charge of $35.00 (no insurance can be filled for a sport physical).

Prescription Renewals
Prescriptions can only be refilled during normal office hours. The on call physician will not prescribe or refill any medication after office hours. When calling in for a refill, the required time needed is 24 - 48 hours to complete your request.  

Our office will make every effort to handle your request in the shortest time possible. When you are calling to renew a prescription, please leave the name and the phone number of your pharmacy along with the name of the medication, dosage and quantity.

NOTE:  ADHD/ADD medications refill prescriptions cannot be called in or mailed out.  These are controlled substances and they require the parent to come to the office to pick up the prescription monthly.  All children on these medications must have a MED-CHECK (office visit) with the physician every 6 months.  It is the parent's responsibility to call and schedule these appointments in a timely manner or request refills in a timely manner so their child does not run out of these medications.

Ear Piercing
Due to many inquiries we are pleased to offer ear piercing in a private sterile environment by our professionally trained personnel. The fee is $35-45 (depending ear ring selected) and is not covered by insurance. Piercing must be with our selection of earrings, which are, sterile 24 karat gold electroplating hypoallergenic (no nickel). After care instructions will also be included. The minimum age requirement is 6 months.

What You Need to Know About Electronic Medical Records (EMR)
Our office does not have paper medical charts, all medical records are maintained by a Electronic Medical Records (EMR) program.  EMR offers maximum confidentiality, improved continuity of care, and advanced record keeping for superior patient care.

Our staff will scan in the paper medical records of patients transferring into our practice to create an electronic chart.  The result will be more thorough in maintaing detailed record keeping for all patient medical information.

Computers are in each exam room to allow our practitioner access to your child's electronic medical records. This allows the practitioner to reference your child's medical history quickly, enter notes and prescriptions, and record other necessary information at the time of the visit or during phone triage.

HIPPA - Notice of Privacy

This information is for educational purposes only and it should be used only as a guide.
Copyright @ 2006-2015 Sunshine Pediatrics