Website Depression Screener

Want to see if you're a good candidate for TMS treatment?

This form helps us see if TMS will be a good treatment for you, and if your insurance will be able to cover the costs of treatment. After you fill out the form, you'll have the option to set up a consultation with one of our TMS coordinators who can answer any questions you have about the treatment and how to get started. Always feel free to reach out to our office at (212) 707-8662 or by emailing us at tms@apphealthgroup.com
Today's date*

MonthDayYear
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
What is your primary insurance?*
How did you hear about APP Health Group *
Other:*
Over the last two weeks, how often have you been bothered by the following problems?
1. Little interest or pleasure in doing things*

Not at allSeveral DaysMore than half the daysNearly every day
2. Feeling down, depressed or hopeless*

Not at allSeveral DaysMore than half the daysNearly every day
3. Trouble falling or staying asleep, sleeping too much*

Not at allSeveral DaysMore than half the daysNearly every day
4. Feeling tired or having little energy*

Not at allSeveral DaysMore than half the daysNearly every day
5. Poor appetite or overeating*

Not at allSeveral DaysMore than half the daysNearly every day
6. Feeling bad about yourself-or that you are a failure or have let yourself or your family down*

Not at allSeveral DaysMore than half the daysNearly every day
7. Trouble concentrating on things, such as reading the newspaper or watching television*

Not at allSeveral DaysMore than half the daysNearly every day
8. Moving or speaking so slowly that other people could have noticed. Or the opposite-being so figety or restless that you have been moving around a lot more than usual*

Not at allSeveral DaysMore than half the daysNearly every day
9. Thoughts that you would be better off dead, or of hurting yourself*

Not at allSeveral DaysMore than half the daysNearly every day
PHQ-9 Calculation
How difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?*

Not difficult at allSomewhat difficultVery difficultExtremely difficult
How many anti-depressant medications do you currently take or have tried in the past?

012345+
Should be Empty:

Want to see if you're a good candidate for TMS treatment?

Over the last two weeks, how often have you been bothered by the following problems?