EEG order form for healthcare providers

The current order form lists routine EEG and ambulatory EEG with video options. The ordering healthcare provider selects the study type and recording length. Contact NeuLine to clarify video arrangements for an individual order.

Before you start the provider order

1. Review the ordered study. Confirm the study type and recording length selected by the ordering healthcare provider.
2. Prepare the referral information. Have patient demographics, supporting medical records and the previous routine EEG report, if applicable, available. Review the EEG referral requirements and checklist.
3. Continue to the order form. Enter the ordering provider’s name and email in the fields below, then select “Proceed to EEG Order Form.”

Opening the order form is not confirmation of order acceptance, insurance authorization, scheduling or test completion.

Have a service question? Review NeuLine’s ambulatory EEG service information.

Patient or caregiver? Review patient preparation and scheduling information.

Enter the ordering provider’s name and email below, then select “Proceed to EEG Order Form.” Review the referral checklist before completing the order.