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Is TMS Therapy Right For Me?

Provided by TMS Medical Associates of NY

This questionnaire will take less than 5 minutes to complete and can help determine if you are a candidate for TMS Therapy. The results of the survey will be available after taking the survey and again by email.

Please be sure to click the "Next Button" after completing this page.

Sincerely, Dr. Alan Manevitz and Dr. James Halper

TMS Medical Associates of NY

Are you taking medication to treat your depression? *This question is required.

Are you still depressed despite your medication? *This question is required.

Are you experiencing side effects from your medication? *This question is required.

If you are experiencing side effects from medication, please check those side effects you are experiencing. *This question is required.(Medications are systemic, meaning that they travel in your blood and to various parts of your body. Often medications have unintended effects in other parts of your body.)

Weight Gain
Decreased Appetite
Constipation / Diarrhea
Decreased Sexual Interest
Increased Sexual Dysfunction
Drowsiness

Insomnia
Nervousness
Anxiety
Weakness
Dry Mouth
Dizziness

Fatigue
Sweating
Tremor
Treatment Discontinuation side Effects

Have you switched medications more than once due to side effects? *This question is required.

How many medications have you tried in treating your depression or other mental health related illnesses? *This question is required.

Are depression symptoms having an effect on your ability to earn a living? *This question is required.

Are depression symptoms and side effects interfering with your leisure activities or relationship with your friends and family? *This question is required.