To request a consultation with the Epilepsy Center at Hartford Hospital, complete the Online Consultation Request Form below.
If you would rather complete a paper consultation request form, download the form (MS Word or PDF format) and fax the completed form to 860-972-5003.
For consultations via telephone please call 860.972.3621 EXT. 5
Online Consultation Request Form
Please note the following:
- This form is to be completed by a referring physician.
- A representative from the Epilepsy Center will contact you within one business day.
After submitting this form, please make sure to fax
the following information to 860-972-5003
CD's or documents can also be mailed to:
Hartford Hospital Department of Neurology
80 Seymour Street.
P.O. Box 5037
Hartford, CT 06102
Attn: Epilepsy Monitoring Unit