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Neurology Center of Fairfax

703-876-0800
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EMG Consent

EMG Consent

Email(Required)

Electromyography (EMG) and Nerve Conduction Studies (NCS) are utilized to help evaluate disorders of the nerves and muscles.

I understand the risks and benefits of the scheduled Electromyography and Nerve Conduction Studies, which may include inserting a thin disposable needle into my muscle and applying mild shocks to my nerves. I understand bruising and discomfort at the site of needle insertion may occur.

Acknowledgment(Required)
By checking the box below and filling in my name and date, I am signing for my consent of this study.
MM slash DD slash YYYY
Rev 9.22.2022
This field is for validation purposes and should be left unchanged.

Locations

Fairfax Office
3020 Hamaker Ct, Suite 400
Fairfax, VA 22031

703-876-0800 | Fax: 703-876-0866
Reston Office
1830 Town Center Drive, Suite 305
Reston, VA 20190

703-876-0800 | Fax: 703-876-0866
Sleep Diagnostic and Treatment Center
3020 Hamaker Ct, Suite 400
Fairfax, VA 22031

703-876-2850 | Fax: 571-308-1158
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