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Diagnostic Neurophysiology (EEG/EMG) Referral

Referrals form

Referrals process

1Download the correct requisition form 

Download the correct requisition form, depending on the type of test you want conducted: 
  • Electroencephalography (EEG) 
  • Electromyography (EMG) & nerve conduction (NC)
  • Evoked potentials

2For an EEG, give the reason for requesting the test  

On the EEG requisition form, give the reason for requesting the EEG. You may check as many as apply.

To determine:

  • If event(s) are seizures
  • Seizure type
  • Epilepsy syndrome
  • Subclinical seizures
  • Non-convulsive status
  • New seizure type

To evaluate:

  • Seizure control followup
  • Change in medication
  • Recurrence or increase in seizures


  • Repeat EEG for sleep
  • To capture an event
  • Decreased level of consciousness – undetermined cause
  • Encephalopathic
  • Other

3For sedated procedures

*We no longer accept direct referrals for pediatric sedated procedures. Any requests for sedated procedures require a neurology consultation.

4If you need a fast EEG report 

Your office can obtain faster EEG results by receiving a faxed report.

Physicians’ offices can contact us for more information by calling 604-875-2124.

SOURCE: Diagnostic Neurophysiology (EEG/EMG) Referral ( )
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