Is TMS Right For Me?

Client Name

Phone Number

Guardian Name

Client Date Of Birth

I have tried more than one medication for my depressive symptoms:

I have tried therapy to reduce depressive symptoms:

I have a history of seizures or diagnosed seizure disorder:

I have have non-removable conductive metal in or near the head:

Over the past two weeks, how often have the following problems bothered you? Please answer to the best of your ability.

1. Little interest or pleasure in doing things