INTAKE FORMS

—

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 to complete, it's important in order to receive TMS treatment.

—

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.

—

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.

—

You can use the PHQ-9 & GAD-7 to screen for depression and measure your level of symptom severity. Both the PHQ-9 and GAD-7 can be used for other disorders such as phobias and generalized anxiety disorder.

—

This Consent to Release Form allows us to disclose information related to your mental health treatment, psychiatric history, or current medications only to specific resources that you specify.

—

Bukhari Psychiatric Services and staff will maintain the privacy of

your health information and will not disclose such information to others without your consent or permission, or unless the law requires us to.