TMS Assessment - Is TMS Therapy right for me?
Do you have epilepsy or have you ever had a convulsion or a seizure?
Have you ever had a fainting spell or syncope? If yes, please describe on which occasion(s)?
Have you ever had a head trauma that was diagnosed as a concussion or was associated with loss of consciousness?
Do you have any hearing problems or ringing in your ears?
Do you suffer from frequent headaches?
Do you have cochlear implants?
Are you pregnant or is there any chance that you might be?
Do you have metal in the brain, skull or elsewhere in your body (e.g., splinters, fragments, clips, etc.)? If so, specify the type of metal.
Do you have an implanted neurostimulator (e.g., DBS, epidural/subdural, VNS)?
Did you ever undergo TMS in the past? If so, were there any problems?
Did you ever undergo MRI in the past? If so, were there any problems?
How soon are you looking to take care of your depression?
As soon as possible
Within the next 3 months
Have you ever been diagnosed with Treatment-Resistant Depression or Major Depressive Disorder (MDD)?
Have you had suicidal thoughts in the past year?
How many antidepressant medications have you tried?
4 or more
Have you ever been diagnosed with Bipolar, Schizophrenia, or other psychotic illnesses?
Yes, but I may have been misdiagnosed
Have you tried therapy, counseling, or coaching?
Yes, it has helped me
Yes, I have tried with insufficient benefits
Yes, but I stopped going because it wasn't working and/or I didn't like it
No, I have never tried it
Have you heard about TMS Therapy before?
Where have you heard about TMS Therapy?
Facebook / Instagram
I have not heard of TMS
Who are you taking this survey for?
Have you abused any of the following substances in the past 12 months?
Tobacco / Nicotine
More than one of these
None of these
Do you currently use any other recreational drugs other than Marijuana?
No, I used to but I stopped
No, I have never tried any
What is your gender?
Rather not say
Do you have health insurance?
Which insurance do you have?
Blue Cross Blue Shield (BCBS)
What is your age?
65 or older
First Name (Please press ENTER after entering your information)
Last Name (Please press ENTER after entering your information)
Phone (Please press ENTER after entering your information)
Email (Please press ENTER after entering your information)
Which TMS location?