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Neurology Center of Fairfax

703-876-0800
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    Neurology Center of Fairfax is implementing Patient Connect by Luma as a way for you to complete your forms online before coming to the office.
    You will receive a text from (703) 574-0867 with your appointment confirmation, reminders, and forms link.
    Please call our office with any questions.

EMG Consent

EMG Consent

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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.

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By checking the box below and filling in my name and date, I am signing for my consent of this study.
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Rev 9.22.2022

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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