Skip to content

Simple TMS Form

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 Dr. Ravi Singareddy for an initial evaluation, if you so desire.

Name
Name
First
Last
Have you been diagnosed with:
Mark all that apply
In your lifetime, have you been on 2 or more antidepressants, mood stabilizers, and/or antipsychotics.? *
Are you currently (or been in the past) in counseling or therapy?
Transcranial Magnetic Stimulation (TMS) is covered by most insurances. My insurance carrier is: