TAKE THE TMS SELF-ASSESSMENT

There is always hope for recovery from depression! Take the self-assessment to find out if TMS is right for you. Your responses and info will remain confidential.

How many antidepressants have you tried? *

0

1

2

3

4 or more

Have you ever been diagnosed with major depression? *

Yes

No

Have you ever been diagnosed with OCD? *

Yes

No

Full Name *

Email *

Phone *

When is the best time to reach you? *

Early Morning

Late Morning

Early Afternoon

Late Afternoon

Anytime

Other

When is the best time to reach you? *

Who is your insurance carrier? *

Aetna

Blue Cross Blue Shield Anthem

Blue Cross Blue Shield Regence

Blue Cross/Blue Shield FEP (Federal Employee Plan)

Blue Cross Blue Shield Other Plan

Cigna

First Choice Health

MODA (formerly ODS)

OHP/Medicaid

Optum

PacificSource Commercial Plan

PacificSource Community Solutions (OHP Plan)

Providence

Tricare

UnitedHealthcare

Medicare

Other

None

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