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.

REQUEST A CONSULTATION

HERE IS OUR LIST OF FORMS

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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 REGISTRATION
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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, 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.

PHQ-9 AND GAD-7
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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.

CONSENT TO RELEASE
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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.

HIPPA NOTICE

FINANCING OPTIONS

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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.

Scan Our QR Code Above To Learn More, Prequalify, or Make a Payment.

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