Our EEG Requisition Form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by applying the patient label at the top of the form, ensuring to include the patient's name, date of birth (DOB), and health card number.
3. Select the type of test requested by checking the appropriate box: Routine, Sleep Deprived, or Urgent.
4. Fill in the referral information section, including the date sent and details of the referring physician. Ensure that you print their name, signature, and CPSO number clearly.
5. Complete the patient information section with accurate details such as primary phone number and any relevant medical history. Attach a consult note if available.
6. In the medications section, indicate whether the patient is taking anticonvulsants or other pertinent medications by checking 'Yes' or 'No'.
7. For technician use only, provide observations regarding patient alertness and cooperation as required.

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