PATIENT FORMS
We look forward to meeting you and discussing your mental health goals. Kindly complete the patient forms located on this page before your appointment to expedite your check-in process. Should you encounter any difficulties with the forms or require assistance from a specialist, please do not hesitate to contact us using the office number below.
HERE IS OUR LIST OF 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, it's important in order to receive TMS treatment. Easily download and print it at home.
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.
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.
PHQ-9 AND GAD-7
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.
CONSENT TO RELEASE
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.
HIPPA NOTICE
Our HIPPA 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.
FINANCING OPTIONS
CareCredit is a health and wellness credit card with flexible financing options so you can pay over time for care you want or need.* Accepted at over 260,000+ locations! TMS New Mexico is proud to offer CareCredit for anyone who might require financial assistance with their TMS treatment. Have questions? Please contact one of our team members.
