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WNC Referral Form

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EEG


Routine EEG with video monitoringSleep Deprived EEGEEG with hyperventilation and photic stimulation24 hour Ambulatory EEG48 hour Ambulatory EEGSedation inducted EEG with Melatonin

Dr Hamid Modarres
Dr Mushriq Al-Khaya

10 Harley Street, LondonParkside Hospital, Wimbledon
Parkside Hospital, WimbledonPrime Health Centre, Weybridge

EMG/Nerve Conduction Study


EMG/NCS/Single Fibre EMGMagnetic StimulationQuantitative Sensory Threshold (QST)Visual Evoked Po10tial (VEP)Somatosensory Evoked Po10tial (SSEP)

Dr Santiago Catania
Dr Hamid Modarres
Dr Martin Schwartz
Dr Mushriq Al-Khayatt

10 Harley Street, London
Parkside Hospital, WimbledonSt Anthony's Hospital, London
Parkside Hospital, Wimbledon
Parkside Hospital, WimbledonClare Park Hospital, FarnhamPrime Health Centre, Weybridge

Cognitive Assessment


Cognitive Assessment

Dr Shai Betteridge
Dr Claire O'Neill

10 Harley Street, LondonPrime Health Centre, Weybridge
10 Harley Street, LondonSt George's Hospital, London

Sleep Study


Ambulatory Respiratory Somnogram

Dr Farid Bazari

Parkside Hospital, WimbledonCoombe Wing, Kingston Hospital

Audiovestibular Investigation


Audiovestibular Investigation

Dr Borka CeranicDr Ewa Raglan

Parkside Hospital, Wimbledon

Vestibular Therapy


Vestibular RehabilitationNeck/back treatmentPosturography

Parkside Hospital, WimbledonPrime Health Centre, Weybridge

Additional clinical information - required.