TMS Therapy Screening

NeuroStar Screening

First Name *

Last Name *

Email Address *

Phone

Best Time to Contact

Current Doctor (if applicable)

NeuroStar Therapy Screening Questions

Are you an adult patient with Major Depressive Disorder? *

Yes

Have you tried at least 4 medications without getting better? *

Yes

Did you experience side effects to any of the 4 medications? *

Yes

Have you previously had ECT or TMS with a 50% reduction in a depression score?? *

Yes

Have you tried an adequate course of therapy? *

Yes

Do you have a history of seizures, magnetic-sensitive metal in their head or any implanted devices? *

Yes

Do you have any specific questions about NeuroStar TMS Therapy?

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If you are human, leave this field blank.

Looking for a helping hand?

Let the professionals at DBH guide you on your path of recovery.

Richmond Office

Dominion Behavioral Healthcare
Main Office & TMS Center
2301 North Parham Rd, Suite 5
Richmond VA 23229

Phone: 804.270.1124
Fax: 804.270.2090

If you are interested in becoming a new patient at DBH, please complete and submit the new patient registration form (18 yrs +) or the child new patient registration form (>18 yrs) linked below.

Welcome! We’re glad you’re here.

Once the completed form is submitted, our new patient coordinator will contact you to review your submission and discuss how DBH may best serve you.

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