To refer a patient for an epilepsy or epilepsy surgical consultation, please fill out the requested information and click on the button labeled "Submit". We will respond within 1 business day.

Refering Physician Information

Patient History

Partial onset epilepsy (includes aura, simple partial seizures, simple motor seizures, frontal nocturnal seizures, complex partial seizures, and secondary generalized tonic clonic seizures)
Primary generalized epilepsy (includes absence seizures, myoclonic seizures, tonic seizures, atonic seizures, clonic seizures, and primary generalized tonic clonic seizures)
Symptomatic generalized epilepsy (includes patients with cognitive abnormalities and seizures)

0
1
2 or more

MRI
PET
EEG
Ambulatory EEG
Video EEG
MEG
Ictal SPECT
Neuropsych evaluation

Patient Contact Information

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