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Epilepsy services at University Health System

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Epilepsy

Neurosciences Home

Epilepsy

Epilepsy Surgery Program

Epilepsy Referrals and Appointments

Epilepsy Resources

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Epilepsy Referrals and Appointments

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To schedule an initial outpatient visit with one of our specialists call	(210) 450-9700
For questions, including medication refills, forms, or to arrange inpatient Video-EEG monitoring	University Hospital Patients (210) 358-1587 UT Medicine Patients (210) 450-9700
To contact the Epilepsy Surgery Case Manager	(210) 358-1544

Epilepsy Monitoring Unit Referral Form

Referring Physician / Clinic Information

Name of Physician / Clinic

Mailing Address

Phone

Fax

Contact Person

Phone

Patient Information

Name

Name of Parent/Guardian (if applicable)

Email Address

Re-Enter Your Email Address

Mailing Address

Home Phone

Cell Phone

Indicate the desired outcome of this admission (Check all that apply)

Spell Characterization
Presurgical Workup
Medication Change

Please write a brief note below if you would like to provide more information on this referral. (We will contact your office when we receive your referral, and we will also contact the patient)

Re-enter code below

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You can also contact us with questions or concerns at:
phone: (210) 358-1587
email: epilepsy@uhs-sa.com

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