Find out if TMS is right for you Self Assessment Test Step 1 of 6 16% There is always hope for recovery! To find out if TMS therapy is right for you, take the self-assessment below.Have you ever been diagnosed or treated for schizophrenia or schizoaffective or bipolar disorder?* Yes No Do you have a metal implant in or around the head?*(aneurysm coil or clip, metal plate, ocular implant, stent or any other metal) Yes No Do you have any of the following other conditions:*cerebrovascular disease, dementia, history of repetitive or severe head trauma, increased intracranial pressure, or primary or secondary tumors in the central nervous system? Yes No Do you have a seizure disorder/epilepsy?* Yes No Unfortunately you are not eligible for TMS at this time. For more information please call our office. Over the past 2 weeks, how often have you been bothered by any of the following problems? 0 (Not at all), 1 (Several days), 2 (More than half the days), 3 (Nearly every day)Little interest or pleasure in doing things* 0 1 2 3 Feeling down, depressed or hopeless* 0 1 2 3 Trouble falling asleep, staying asleep, or sleeping too much* 0 1 2 3 Unfortunately you are not eligible for TMS at this time. For more information please call our office. Over the past 2 weeks, how often have you been bothered by any of the following problems? 0 (Not at all), 1 (Several days), 2 (More than half the days), 3 (Nearly every day)Feeling tired or having little energy* 0 1 2 3 Poor appetite or overeating* 0 1 2 3 Feeling bad about yourself - or that you're a failure or have let yourself or your family down* 0 1 2 3 Over the past 2 weeks, how often have you been bothered by any of the following problems? 0 (Not at all), 1 (Several days), 2 (More than half the days), 3 (Nearly every day)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.* 0 1 2 3 Trouble concentrating on things, such as reading the newspaper or watching television* 0 1 2 3 Thoughts that you would be better off dead or of hurting yourself in some way* 0 1 2 3 Do you have extended health coverage?* Yes No How many antidepressants have you tried?* 0 1 2 3 4 Have you been through counseling or psychotherapy?* Yes No Have You Had Prior TMS Treatment?* Yes No Based on your answers, TMS may be right for you! Fill out the rest of the form and we will contact you to book your complimentary consultation. This form is PHIPA compliant. Your information is secure and will not be shared or sold to any third parties. Your information is only being used to help determine if you are a candidate for TMS.First Name*Last Name*Email* Phone*Postal Code* Postal Code How did you hear about us?Referred by another patient680 NewsCfrb 1010Internet SearchDoctor ReferralHeard from a friendYorkville PostThornhill PostAdditional Information In every person there lies a soul with unlimited hope and strength.
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