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

 

 
Raleigh Neurology Neuro-Ophthalmology Services

Raleigh Neurology Associates is pleased to announce the association of Syndee J. Givre, M.D., Ph.D., in the practice of Neuro-ophthalmology.

Syndee J. Givre, M.D., Ph.D.

A native of New York, Dr. Givre graduated from the State University of New York at Stony Brook as valedictorian. She earned both and M.D. and a Ph.D. in Neuroscience in the Medical Scientist Training Program at Albert Einstein College of Medicine. She trained in Ophthalmology at the Mount Sinai Medical Center in New York and completed a fellowship in Neuro-ophthalmology at the University of Iowa Hospitals and Clinics. Dr. Givre is certified by the American Board of Ophthalmology. Dr. Givre is currently a member of the Board of the North Carolina Society of Eye Physicians and Surgeons.

Dr. Givre specializes in diagnosing and treating conditions affecting the nerves of the eye, eye socket and brain that affect vision and eye movements and pupil size. She sees patients with optic nerve disorders such as optic neuritis, optic nerve stroke, swollen optic nerves, papilledema and other abnormal appearing optic nerves. She evaluates patients with unexplained visual loss, transient vision loss and vision loss due to optic nerve, brain and neurologic problems such as multiple sclerosis and tumors. Patients with unequally sized pupils and double vision, for example from cranial nerve palsies, stroke, brain tumors, multiple sclerosis, thyroid eye disease and myasthenia gravis are also evaluated.

Dr. Givre evaluates patients with the following problems:

  • Ischemic optic neuropathy
  • Tumors of the optic nerve (gliomas and meningiomas)
  • Tumors compressing the optic nerve and visual pathways (pituitary adenomas)
  • Papilledema, idiopathic intracranial hypertension, pseudotumor cerebri
  • Optic neuritis, demyelination of the optic nerve related to multiple sclerosis
  • Optic nerve inflammation (sarcoidosis, systemic lupus erythematosus)
  • Toxic optic neuropathy
  • Metabolic optic neuropathy
  • Hereditary optic neuropathy (Leber's Hereditary Optic Neuropathy, dominant
    optic atrophy)
  • Giant cell or temporal arteritis
  • Unexplained vision loss
  • Transient vision loss (amaurosis fugax, transient ischemic attacks)
  • Vision loss due to brain lesions affecting the visual pathways (strokes, tumors, infections, inflammation)
  • Double vision
  • Abnormal eye movements (nystagmus)
  • Abnormal pupils (unequal pupils, Horner's Syndrome, Adie's Pupil)
  • Graves' Disease/thyroid-related eye disease
  • Ocular myasthenia gravis

 

Raleigh Neurology Neuro-ophthalmology Department
1520 Sunday Drive
Raleigh, NC 27607-6000
Phone: 919-325-4260
Fax: is 919-325-4680  

To contact us or to schedule an appointment click here.