Please choose the form and submission method:
Online Forms via DocuSign:
Long-Term Video Ambulatory EEG (Online) Routine EEG (Online)
Form Downloads to be completed digitally via Adobe, or printed and completed by hand:
Long-Term Video Ambulatory EEG (Download) Routine EEG (Download)
Once the form is completed:
Please send a copy of the front and back of insurance cards, patient demographic sheet, clinical notes and routine EEG report
Send the completed order form and accompanying documents to GND:
Email: billing@globalneuro.com
Main Fax: 1-877-290-1544
Alternate Fax: 469-312-3628
