Is TMS right for you?

1

Over the past 2 weeks, how often have you had little interest or pleasure in doing things?* This field is required.

Not at all

Several days

More than half the days

Nearly every day

2

Over the past 2 weeks, how often have you been feeling down, depressed or hopeless?* This field is required.

Not at all

Several days

More than half the days

Nearly every day

3

Over the past 2 weeks, how often have you had trouble falling or staying asleep or sleeping too much?* This field is required.

Not at all

Several days

More than half the days

Nearly every day

4

Over the past 2 weeks, how often have you been feeling tired or having little energy?* This field is required.

Not at all

Several days

More than half the days

Nearly every day

5

Over the past 2 weeks, how often have you had poor appetite or overeating?* This field is required.

Not at all

Several days

More than half the days

Nearly every day

6

Over the past 2 weeks, how often have you been feeling bad about yourself or that you are a failure or have let yourself or your family down?* This field is required.

Not at all

Several days

More than half the days

Nearly every day

7

Over the past 2 weeks, how often have you had trouble concentrating on things, such as reading newspapers or watching television?* This field is required.

Not at all

Several days

More than half the days

Nearly every day

8

Over the past 2 weeks, how often have you been moving or speaking so slowly that people could have noticed? Or the opposite, being so fidgety or restless that you have been moving around a lot more than usual?* This field is required.

Not at all

Several days

More than half the days

Nearly every day

9

Over the past 2 weeks, how often have you had thoughts that you would be better off dead or hurting yourself in some way?* This field is required.

Not at all

Several days

More than half the days

Nearly every day

10

Name* This field is required.

First Name

Last Name

11

Phone Number* This field is required.

Area Code

Phone Number

12

Email* This field is required.

example@example.com

13

Results

14

Your score shows you may have: Minimal depression or normal mood changesWould you like Valley Medical to contact you to schedule a consultation?

YESNO

15

Your score shows you may have: Mild depressionWould you like Valley Medical to contact you to schedule a consultation?

YESNO

16

Your score shows you may have: Moderate depressionWould you like Valley Medical to contact you to schedule a consultation?

YESNO

17

Your score shows you may have: moderately severe depressionWould you like Valley Medical to contact you to schedule a consultation?

YESNO

18

Your score shows you may have: Severe depressionWould you like Valley Medical to contact you to schedule a consultation?

YESNO