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Department of NeurologyPatient Referral Intake Form 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the patient's name and date of birth in the designated fields at the top of the form. This information is crucial for identifying the patient.
- Next, fill in the referring physician's details, including their name, telephone number, and fax number. Ensure accuracy to facilitate communication.
- Provide the patient's chief complaint in the specified section. This helps in understanding the reason for referral.
- Complete sections on best corrected vision and color vision by entering relevant data as per examination results.
- Fill out external exam findings, including IOP measurements and visual fields. Be thorough to ensure comprehensive documentation.
- Finally, document diagnosis and treatment plans clearly. Include follow-up instructions if necessary.
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What does a neurology referral mean?
Neurologists are specialists who can assess, diagnose, manage, and treat conditions that affect your nervous system. Your doctor might refer you to a neurologist if youre having symptoms that could be caused by a neurological condition, such as pain, memory loss, trouble with balance, or tremors.
Why would you be referred to neurology?
Some of the more common symptoms for which you may want to see a neurologist (or be referred to one) include: Memory disturbances, forgetfulness. Loss of consciousness. Seizures.
Is it serious to be referred to a neurologist?
A neurologist can help confirm or rule out the potential causes so you can get the proper care. As neurologists, we may not always find the ultimate cause of your symptoms, but often were able to eliminate the more serious conditions, Zacharias says.
What to expect when referred to neurology?
They will also do a physical examination. Neurological examinations can take a long time, because so much in the body is controlled by your nervous system. Your neurologist will look at any previous test results, and may organise more tests. Your neurologist can create a treatment plan for your condition.
Do I need a referral for UW neurology?
A primary care provider must refer patients on managed care plans. Self referrals are acceptable in certain circumstances. When making a physician referral, please complete a UW Medicine referral request.
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