Neurological Serology Indications Survey
Please complete this survey to provide information on neurological serology testing indications.
Patient Full Name
*
First Name
Last Name
Patient Age
*
Gender
*
Male
Female
Other
Primary Neurological Symptoms
*
Seizures
Cognitive Impairment
Movement Disorders
Peripheral Neuropathy
Encephalopathy
Other
Relevant Medical History (e.g., autoimmune diseases, infections, malignancy)
Indication for Serology Testing
*
Diagnostic Workup
Disease Monitoring
Screening
Other
Requested Neurological Serology Tests
*
Anti-NMDA Receptor Antibodies
Anti-LGI1 Antibodies
Anti-GAD Antibodies
Paraneoplastic Panel
Infectious Serologies (e.g., HSV, VZV, HIV)
Other
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