Patient forms
TMS Patient Forms
TMS has its own paperwork because insurers require documentation before they will authorise treatment. Completing it early is what keeps your start date from slipping.
The forms in this packet
You can print these and complete them before your visit, or arrive 15 minutes early and fill them in here.
New Patient Form
Contact details, insurance information and basic history.
New Patient FormPDF · 380 KBPatient Consent for Treatment — TMS
Consent specific to NeuroStar TMS therapy, including the safety screening.
Patient Consent for Treatment — TMSPDF · 358 KBPatient Health Questionnaire
A short symptom and history questionnaire your clinician reviews before the visit.
Patient Health QuestionnairePDF · 356 KBMedical Records Release
Authorises us to request or send records to another provider.
Medical Records ReleasePDF · 58 KBPsychotherapy Notes Release
A separate authorisation, required specifically for therapy notes.
Psychotherapy Notes ReleasePDF · 65 KB
Looking for a different packet? Patient Forms or Living Free 365 Patient Forms.
What is in the packet
- TMS safety screening — metal implants, devices, seizure history
- Treatment history: medications tried, doses, and how long you stayed on each
- Depression rating scales used to measure your response over the course
- Informed consent for NeuroStar TMS
- Insurance and prior authorisation information
Why the medication history matters so much
Nearly every plan requires evidence that antidepressants did not give you enough relief before it will cover TMS. The more precise you can be about names, doses and dates, the faster the authorisation goes through. Approximate is fine — guesswork slows things down.
The safety screen is not a formality
Answer the implant and seizure questions carefully. Certain metal implants near the head rule TMS out, and your physician needs that information before your mapping appointment.
What happens next
- 1Call (502) 454-8800 and ask for the TMS packet.
- 2Return it before your consultation so we can start prior authorisation.
- 3We contact you as soon as your insurer responds and book your mapping session.
Prefer to talk? Call (502) 454-8800. We respond within one business day.
Request an appointment
Tell us how to reach you and what you're looking for. We'll confirm your insurance, answer your questions, and find a time that works. No long intake before you hear from a person.
- We respond within one business day.
- Most insurance accepted, including TRICARE and Medicare.
- In-office visits on Newburg Road, plus telehealth.
