Is dTMS right for me? (Self Assessment) Please enable JavaScript in your browser to complete this form.Do you have a seizure disorder/epilepsy? *YesNoDo you have a metal implant in or around the head? *YesNoHave you ever been diagnosed or treated for schizophrenia or schizoaffective or bipolar disorder? *YesNoDo you have any of the following conditions: Cerebrovascular Disease, Dementia, History of repetitive or severe head trauma, increased intra-cranial pressure, primary or secondary tumors in the central nervous system? *YesNoLittle interest or pleasure in doing things. Selected Value: 0 Feeling down, depressed or hopeless Selected Value: 0 Trouble falling asleep, staying asleep, or sleeping too much. Selected Value: 0 Feeling tired or having little energy Selected Value: 0 Poor appetite or overeating Selected Value: 0 Feeling bad about yourself or that you’re a failure or have let yourself or your family down. Selected Value: 0 Moving or speaking so slowly that other people could have noticed or the opposite: being so fidgety or restless that you have been moving around a lot more than usual. Selected Value: 0 Trouble concentrating on things, such as reading the newspaper or watching television. Selected Value: 0 Thoughts that you would be better off dead or of hurting yourself in some way. Selected Value: 0 How many antidepressants have you tried? Selected Value: 0 Are you going through or have done counseling or psychotherapy? *YesNoHave you had prior TMS treatment? *YesNoName *FirstLastEmail *Insurance *Blue Cross and Blue Shield of TexasUnited HealthcareAetnaCignaMedicareAmerigroupMagellan Behavioral HealthSuperior HealthplanUnited Medical ResourcesHow did you hear about us?Additional InformationSubmit
