For Physicians

Thank you for your referral to the Queen’s Neuroscience Institute. We look forward to providing the best neurological care for your patients. 

Referral Forms

Please complete the necessary form and attach supporting patient notes.


Neuroscience Institute Outpatient Center Referral Form

Download Form


Neurodiagnostic Testing Referral Form

Download Form


Additional Referral Instructions

For patients being referred to Drs. Laura Miller, Sung Bae Lee, Victoria Wong or Alan Stein: Please have any images specific to the brain sent to Queen’s prior to appointment or brought on a CD-ROM at the time of consultation if Imaging was performed outside of Queen’s.

Please contact the Neuroscience Institute Outpatient Center at 808-691-8866 with any questions.