Psychvisit TMS Check In
Date of Service
*
/
Month
/
Day
Year
Date of Visit
Hour Minutes
AM
PM
AM/PM Option
Patient Name
*
First Name
Last Name
Date of Birth:
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Month
/
Day
Year
Have you had any of these issues in Past 24 Hours?
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Alcohol Use
Drug Use
Sleep Deprivation
Change in Medications
None of the Above
TMS visitor Log
*
https://form.jotform.com/drfrafiq/tms-visitor-log
I Accept:
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That No changes in medication should occur during TMS treatment to prevent alterations in the motor threshold. Therefore, if there is any requirement for medication refills during the course of treatment, the patient should promptly inform the TMS treatment operator, who will then relay the information to the doctor.
Check in
Should be Empty: