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 bipolar disorder, schizoaffective disorder or schizophrenia?*YesNoDo you have a metal implant in or around the head (aneurysm coil or clip, metal plate, ocular implant, stent or any other metal)?*YesNoDo you have any of the following: cerebrovascular disease, dementia, history of repetitive or severe head trauma, increased intracranial pressure, or primary or secondary tumors in the central nervous system?*YesNoDo you have a seizure disorder/epilepsy?*YesNoUnfortunately 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*0123Feeling down, depressed or hopeless*0123Trouble falling asleep, staying asleep, or sleeping too much*0123Unfortunately 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*0123Poor appetite or overeating*0123Feeling bad about yourself - or that you're a failure or have let yourself or your family down*0123 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.*0123Trouble concentrating on things, such as reading the newspaper or watching television*0123Thoughts that you would be better off dead or of hurting yourself in some way*0123 Do you have extended health coverage?*YesNoHow many antidepressants have you tried?*01234Have you been through counseling or psychotherapy?*YesNoHave you had a previously successful trial of TMS Therapy?*YesNo 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*Where did you hear about us?Referred by another patient680 Newscfrb 1010Internet SearchReferred by DoctorHeard from a friendAdditional Information Δ In every person there lies a soul with unlimited hope and strength.
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