Transcranial Magnetic Stimulation (TMS) Services at Ellie

Transcranial Magnetic Stimulation (TMS) Services at Ellie

To request TMS services, please complete the following form. A member of the Ellie team will be in touch within 2 business days. Please note, TMS services are only offered at our Maple Grove location at this time.
Is This Patient 18 Years of Age or Older?*

YesNo
Please email us at TMS@elliementalhealth.com to discuss TMS requirements.
Does This Patient Have Major Depressive Disorder (MDD) as a Primary Diagnosis?*

YesNo
Please email us at TMS@elliementalhealth.com to discuss TMS requirements.
Has This Patient Tried 4 Antidepressants in the Current Episode of Depression?*

YesNo
Please email us at TMS@elliementalhealth.com to discuss TMS requirements.
Does This Patient Have Bipolar Disorder, Schizophrenia, or Epilepsy?*

YesNo
If yes, patient is ineligible for TMS at this time.
Has This Patient Tried Psychotherapy?*

YesNo
Please email us at TMS@elliementalhealth.com to discuss TMS requirements.
Does This Patient Have Metal or Medical Devices Implanted in Their Body?*

YesNo
This does not include dental fillings!

If yes, patient is ineligible for TMS.
Patient Name*

First NameLast Name
Preferred Name
Pronouns
Date of Birth*

MonthDayYear
Date
Patient Phone Number*

Area CodePhone Number
Patient Email*
example@example.com
Patient Address*
Insurance Company Name *
Is the patient a current or past Ellie client?*
How did you hear about us?*

Internet Search (Google)Friend or Family MemberAnother Provider (ie. Doctor, case manager)An online advertisement (Facebook/YouTube)Psychology TodayOther Media (i.e. radio or TV)NewsletterAt a Community Event (ie. resource fair, presentation)Other
Please verify that you are human*
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