Benefits

Please fill out this confidential form so that we can verify your current insurance plan’s TMS Therapy benefits.


Member Name *
Member Name
Member Phone Number
Member Phone Number
Select your current insurance carrier
Please write in the Member ID on your insurance card.
(MM/DD/YYYY)
Have You Previously Been Prescribed Anitdepressants? *
 

REFERENCE MEDICATIONS GUIDE HERE

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

 

WE CONTRACT WITH ALL MAJOR CARRIERS:

 
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