Benefits

Fill out this private and confidential form to run your insurance benefits for TMS Therapy.


Name *
Name
Phone
Phone
Select your current insurance carrier
Please write in the Member ID on your insurance card.
(MM/DD/YYYY)
Please list Street Number & Name, City/State/Zip
Please list a brief summary of any antidepressant or other psychiatric medication trials.
 

By hitting submit, you are agreeing to our Benefits & HIPAA policy

 

WE CONTRACT WITH ALL MAJOR CARRIERS:

 
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