Neurophysiology (EEG) Order Form

Schedule an Outpatient Neuro-Diagnostic Study

Use our algorithm to determine a patient treatment path for intractable epilepsy.

Physician Office Instructions

To schedule your patient for an outpatient neuro-diagnostic study at Children’s (i.e., EEG, Ambulatory EEG, EMG); the following order form must be completed legibly and faxed to 404-785-2204 for Children's at Scottish Rite or Forsyth, or 404-785-1795 for Children's at Egleston. Please make sure that the entire order form is completed. Any omission of information will delay scheduling your patient.

EEG Patient Form

  • Download the EEG Order Form
  • Once we receive your order, you will receive a return fax with the first available date and time. In addition, it is very important that the patient family instructions (see below) be discussed with a parent or legal guardian. Proper compliance of these instructions will ensure a precise recording. If a precert/auth is required, it is the responsibility of the ordering physician office to obtain it. All precerts/auths must be received via fax to our office two weeks prior to the scheduled appointment. If a precert/auth has not been obtained, the appointment will be cancelled.

Patient Family Instructions

  • Patients age 13 months and over must be at least four hours sleep-deprived (patient should sleep no more than four hours the night before the study, as we need to obtain natural sleep brain wave patterns). We do not sedate patients for the study. The study will last approximately 1 - 1.5 hours. 
  • Patients must have clean hair (No oils, gels, sprays or lotions).
  • Patient must refrain from refined/processed sugars (natural sugars are acceptable) or caffeine for 24 hours prior to study.
  • Patients must arrive 30 minutes prior to their appointment to register in the Patient Registration Dept., 1st floor. If the patient is 15 or more minutes late, then the appointment may be cancelled.

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