New Patient Forms

(see below for New Child Patient Forms)

New Adult Patient Registration
(PDF / Online)

HIPAA Notice (Privacy Policy)
(PDF / Online)

Acknowlegement of Receipt of Notice of Privacy Practices
(PDF / Online)

Authorization to Release Health Information
(HIPAA Release)
(PDF / Online)

Medical Records Release
(PDF / Online)

Patient Forms

Headache Diary
(PDF)

Sleep Diary
(PDF)

Sleep Study Information
(PDF)

Sleep Study Questionnaire
(PDF / Online)

Comment or Complaint
(PDF / Online)

Narcotic Contract
(PDF / Online)

Child Neurology Forms

New Child Patient Registration
(PDF)

New Child Patient Registration (Patients of Dr. Milowic only)
(PDF)

Child Patient Profile
(PDF)

HIPAA Acknowledgement
(PDF)

Child Medical Records Disclosure and Medical Records Release
(PDF / Online)

Guardian Release Form
(PDF / Online)

Child Headache Calendar
(PDF)

Sleep Diary
(PDF)

Neuro-ophthalmology
Forms

Patient History Form
(PDF / Online)

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.

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.