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TMS - Screener - English SIMPLE

In order to facilitate your assessment for Transcranial Magnetic Stimulation (TMS) services, we ask you to please complete this TMS Assessment Questionnaire. Once you submit it, we will contact you within 24-48 hours to discuss your treatment options and schedule an appointment with Alfredo Arellano PMHCNS-BC for an initial evaluation, if you so desire.

Please input your email address
Please make sure this is correct, we will contact you using this number
I am interest in Transcranial Magnetic Stimulation for;*
Have you been diagnosed with Depression?*
Depressive symptoms that you are currently experiencing include (check all that apply):
Anxiety Symptoms that you are currently experiencing include (check all that apply):
Are you currently in counseling or therapy with a psychologist, psychiatrist, counselor or therapist?
In my lifetime, have you been on 2 or more antidepressants, mood stabilizers, and/or antipsychotics*
Have you had brain surgery or do you have no metals in my head (like aneurysm clips or coils, brain stimulators, cochlear implants etc..).
I am interested in Transcranial Magnetic Stimulation Treatments because:*
Transcranial Magnetic Stimulation (TMS) is covered by most insurances. My insurance carrier is: