Alaska Neurodiagnostics Specialists

For Referring Providers

Everything you need to refer a patient for EEG services

How to Submit a Referral

Please PRINT out the EEG Referral Form and FAX the completed form along with all required documents to:

Fax: 1-800-920-5401

EEG Referral Form

Download and print our EEG Referral Form. All fields must be fully completed prior to scheduling a vEEG study.

Download Referral Form (PDF)

Required Documentation

The following documentation must be faxed to 1-800-920-5401 to allow referral processing and scheduling:

Completed EEG Referral Form

All fields must be fully completed

Routine EEG Report

If applicable, within the last 12 months

Copy of Insurance Cards

Front and back, if not included in patient demographics

Most Recent Clinical Notes

Patient Demographics & Current Medication List

Authorization & Travel Requirements

Prior authorizations (for insurance plans that require them) must be completed by the referring provider's office before scheduling. Alaska Neurodiagnostics Specialists, LLC does not submit prior authorizations. Referrals lacking required prior authorization cannot be scheduled.

Travel arrangements are coordinated after a study date and time are scheduled. Once scheduling is completed, Alaska Neurodiagnostics Specialists, LLC will issue a Travel Request Letter to the referring provider's office. The referring provider's office is responsible for completing all required travel arrangements.

Important: Tricare / Triwest Patients

If this is a Tricare / Triwest patient, a prior authorization needs to be completed by the referring facility before the referral can be processed.

Referral Criteria

Alaska Neurodiagnostics Specialists, LLC requires that all referral criteria outlined above be fully completed prior to scheduling a vEEG study. Referrals that do not meet these requirements cannot be scheduled.

Our Services for Your Patients

Routine EEG

1-hour outpatient studies at our Anchorage and Wasilla clinics

Long-Term vEEG

24, 48, or 72-hour video EEG monitoring

Ambulatory In-Home vEEG

Available in Anchorage, Mat-Su Valley, and Fairbanks

Board-Certified Interpretation

Reports sent directly to referring providers

Contact Us

Questions about the referral process? Our team is here to help.

Fax

1-800-920-5401