* Required Information
How long have you been suffering from depression?
*
Less than 2 weeks
1-6 months
6-12 months
1-2 years
2-4 years
More than 2 years
How did you hear about our non-invasive TMS Therapy services?
*
Dr. Oz
The Doctors
Facebook / Google
Radio
Have you been diagnosed with bipolar, schizophrenia, or other psychotic illnesses?
*
Yes
No
How many antidepressant medications have you tried?
*
None
1-2 medications
3-4 medications
4 or more medications
Have you tried counseling?
*
Yes, I have tried it and failed
Yes, but I stopped going because it wasn't working/I didn't like it
No, I have never tried it
Has your doctor ever used medications other than antidepressants to help you feel better?
*
Yes, I have tried Xanax, Abilify, Lamictal, or other medications
No, I have only tried antidepressants
Please tell us about yourself
*
Male
Female
Age
*
18-24
25-49
50-64
65 & Older
Which insurance do you have?
*
Aetna
BCBS
Medicare
Medicaid
Other
I so not insurance
How soon are you looking to take care of your depression?
*
Right now!
As soon as possible
This week
This month
Treatment-Resistant Psychiatry
TMS Treatment
Telepsychiatry
Substance Abuse Treatment
Counseling