NEW PATIENT FORMS

We look forward to assisting your family.

Prior to scheduling your new patient appointments we will need the below information filled out, completed and returned to our office. 

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Please fill out the below PDF files so that we can create a patient profile and schedule you for your new patient appointment.

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Files  can be faxed at 404-303-7837 or emailed to practiceadmin@therubincenterforautism.org

Demographic Sheet 

New Patient Questionnaire 

FOR COMPREHENSIVE DIAGNOSIS AND COORDINATION OF CARE

I. LESLIE RUBIN, MD.
Developmental Pediatrician 

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750 Hammond Drive

Building 1 Suite 100
Atlanta, GA 30328

Office hours are:
Monday and Thursday :
9:00 am - 4:00 pm
Wednesday :

10:00am- 3:00pm

Autism Spectrum Disorders    Pervasive Developmental Disorder (PDD/NOS)    Asperger's Syndrome   ADD/ADHD 

Developmental Delay   Learning Disabilities     Cerebral Palsy  Medical Complexity    Intellectual Disability  Challenging Behaviors 

Speech Delay  Sensory Integration    Sensory Processing     Auditory Processing Disorder   Hypotonia   Dyspraxia     

Environmental Factors   Prematurity    Fetal Alcohol Syndrome    Genetic Syndromes     Down Syndrome    Fragile X               

Assistance for Children with Disabilities   Katie Beckett Deeming Waiver   Domestic and International Adoption