You can download copies of these forms to use at your convenience. You will need Acrobat Reader to view the file. Acrobat Reader is free and can be obtained from the Adobe site.

New Patient Forms

(see below for New Child Patient Forms)

New Adult Patient Registration

HIPAA Notice (Privacy Policy)

HIPAA Acknowledgement

Adult Medical Records Disclosure and Medical Records Release

Patient Forms

Headache Diary

Sleep Diary

Sleep Study Information

Sleep Study Questionnaire

Comment or Complaint

Narcotic Contract

Child Neurology Forms

New Child Patient Registration

HIPAA Acknowledgement

Child Medical Records Disclosure and Medical Records Release

Guardian Release Form

Child Patient Profile

Child Headache Calendar

Sleep Diary

Map to Our Office

Map to RNA

Ambulatory EEGs

Preparations for Ambulatory EEG:

• Wash your hair the night before, leaving no hair spray, gels, oils, or hair weaves.
• Eat and take medication as usual (unless instructed otherwise).
• Wear a button front shirt. Plan to wear button front shirts for the duration of the EEG.
• You may be given supplies and instructions to remove equipment. Equipment should be returned at the time requested. Another patient will be scheduled based on the return time.

Please contact the Raleigh Neurology Neurodiagnostic Department at 919-420-6086 with questions regarding your EEG test. Test results are not available in this department. Your doctor will instruct you how to follow up regarding test results, etc.