Patient Forms
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Patient Forms

Kindly use the buttons or quick links provided below to obtain, print, and fill out our patient forms in advance at your convenience. In the event that you encounter difficulty downloading our patient forms or documents, we suggest arriving 15 to 30 minutes before your appointment to allow sufficient time for completion.

REQUEST A CONSULTATION

Check Our Provided Patient Forms Available for Download

We are excited to meet you and discuss your mental health issues and objectives. We make every effort to adhere to our scheduled appointments. In order to expedite your check-in process, we suggest completing the patient forms available on this page prior to your visit. If you encounter any problems with the forms or require assistance from a specialist, please do not hesitate to contact us using the office number provided below.

FOR QUESTIONS, PLEASE CALL US AT (585) 201-8508

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tms therapy and depression treatment patient forms

TMS Registration

Our TMS Registration Form pdf is based on the same information that will be required on your insurance’s prior authorization form. While we understand the form can be tedious to complete, it is an important step in your TMS treatment path.

Registration Form
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TMS Exclusion Criteria

Please complete the following pdf form prior to the start of your TMS treatment. If you have selected any of the boxes under the Contraindicated Section, then TMS therapy is contraindicated, and therefore, would not be a viable treatment option for you.

Exclusion Criteria
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Medication Checklist

The following PDF contains a list of common medications that are used to treat depression. If you have brought a medication list or had your records sent from your physician’s office, please fill out this form and bring those documents to your consultation.

Checklist Download
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PHQ-9 and GAD-7

You can use the PHQ-9 and GAD-7 to screen for depression and anxiety, respectively, as well as measure the level of symptom severity in people with these conditions. 

PHQ-9 and GAD-7
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