Please download the form below, and fax it to the Falcon Epilepsy Freedom Center along with the patient's insurance, demographic (phone, address, dob etc) information along with a clinic note by the referring physician/provider documenting the medical necessity for the Video EEG test. This form also can be filled out using Adobe if you download it to your computer
We know that your time is very valuable. We understand the demands placed on today’s physician, and we want to help share that load. Please send us the referral and we will take of the rest, from confirming the appointment, to verifying benefits, and delivering your results. We promise to do everything in a timely and professional manner so that you can complete your diagnosis as soon as possible, and start a treatment plan right away.
Results Delivered on Time
We are committed to providing the shortest turnaround time, so that you can complete your diagnosis and start a treatment plan for your patient.
To achieve this, once the appointment is created, we will confirm the appointment and follow up with your patients to make sure that they are completely at ease, and answer any questions that they might have. You can also create a referral via the fax (407-365-3034) or email ([email protected]).
Once the diagnostic procedure is completed, all the information is compiled into one report that can be sent to the referring physician/provider via fax and/or email.
Our trained and certified specialists are the best in the industry. They have been recognized by the industry to provide the best possible patient care and testing experience. They bring years of experience and technical knowledge, and are constantly keeping up to date with the latest industry developments. Your patients will be very comfortable in our facility. An attendant will be present at all times there to answer any questions and address any concerns they might have.
Modern Patient Friendly Equipment
We have installed the latest equipment for Video EEG Epilepsy Monitoring Unit evaluation. These systems have been recognized by the industry to deliver the accurate and precise results. They are completely safe and non-invasive. For more information, please feel free to call us, or schedule a visit to come visit our facility. We are very proud of our labs, and love to show them off!