Information form EGG /Single Brain Map / QEEG / Loreta Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Information provider (your) name: *Email : *Phone Number: *Patient Full Name: *Patient BirthDate: *Referring Doctor's name:Diagnosis if Available:Previous Tests and Evaluations:available(bring it during examination)Not AvailableMain Complaint: * if Number: doctor Medications Used, if any:CheckboxesSeizuresHearing ProblemVision ProblemChest Allergy (Asthma)Food AllergyChronic HeadacheSleep DisorderMotor ProblemsSwallowing DifficultiesSwallowing DifficultiesothersChoose your doctor :Prof. Dr. Reham El-Husseiny : Professor of Pediatrics, Head of Unit, and Consultant in Developmental and Behavioral Disorders – Ain Shams UniversityProfessor Dr. Mennatallah Shata : Professor of Pediatric Neurology and Disabilities ,Ain Shams University,eDr/ Amani Kohail : Specialist in treating children with special needs Specialist in monitoring healthy mental and cognitive development for children Certified consultant and trainer in Neurofeedback and Biofeedback therapyPsych/ Alyaa El Marhamy : Clinical psychologist CBT (Cognitive Behavioral Therapy) Specialist Cognitive Neurologist Neurofeedback Expert Master's degree in Cognitive Neuropsychology (Cairo University)Spec/Sherief El Mahdy:Neurofeedback Specialist Learning Difficulties and Skills Development Specialist Speech Specialist and Trainer at the Speech Unit Psychological Tests and Measurements SpecialistSubmit
