Home Order

We contact your patient directly to schedule appointment. We strive to book no further out than one month from date of receiving order; a report will be available in LMR, and a hard copy will be mailed/faxed to you no more than two weeks after the study was performed. If planning a follow up for your patient, please do so at least 2 months after this ambulatory EEG was requested. 

 Please fill out and submit form below:

Patient Name (required)

Patient Email (required)

Home Phone Number (required)

Work Phone Number

Cell Phone Number

Patient Address

Diagnosis

Doctor Ordering

Ordering Doctor Phone Number

Best Time To Reach Patient

 

Informational Patient Packet