WASATCH TMS Patient Forms

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's important in order to receive TMS treatment. Easily download and print at home.

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.

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.

You can use the PHQ-9 and GAD-7 to screen for depression, as well as measure the level of symptom severity in people with depression. Both the PHQ-9 and GAD-7 can be used for other anxiety disorders such as phobias and generalized anxiety disorder.

This Consent to Release Form allows us to disclose information specifically related to your treatment, your psychiatric history, and may include current medications only to specific resources that you specify.

Our HIPAA notice protects you as a patient. We will maintain the privacy of your health information and will not disclose your information to others without your permission, or unless the law requires us to do so.