Appointment Request / Insurance Check

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This appointment is for:* This field is required.

Free New Client Initial Consult With Dr. Hashemian

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Myself

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Patient's Date of Birth* This field is required.

Date

Patient's Name* This field is required.

First Name

Last Name

Patient's Gender

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What is Your Name?* This field is required.

Your First Name:

Your Last Name:

What is Your Email?* This field is required.

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Your Phone Number Which Can Receive Texts:* This field is required.

Best number to reach you during business hours (we will not contact you other than for appointment reminders or to answer your questions):

In which of our offices would you like to receive our services?* This field is required.Some services are offered at home, but at least one office visit is required.

Modesto

San Jose

San Ramon

Can You Drive This far?

For patients covered by insurance, TMS is a daily treatment (Monday-Friday) for seven weeks. Self-pay patients can receive multiple treatments a day and complete the process in two weeks. Neurofeedback and Auditory Training can be done at home.

Your ZIP code and press ENTER:* This field is required.Let's find out the distance and your travel time.

Your ZIP code and press ENTER::* This field is required.Let's find out the distance and your travel time.

I'm sorry, but we are too far away to offer you a free appointment. We do offer a 25-minute paid consultation for $195, which will be credited towards any services you use, you can also call us at 925-871100

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I am interested in finding out more about:* This field is required.

I am not sure

Functional qEEG Brain Mapping [We Do Not Accept Insurance For This Service]

TMS (Insurance Might Cover for Depression, 18+ with 2 or more antidepressants)

Neurofeedback [We Do Not Accept Insurance For This Service]

Auditory Training [We Do Not Accept Insurance For This Service]

tDCS [We Do Not Accept Insurance For This Service]

Full Diagnostic Evaluation [We Do Not Accept Insurance For This Service]

My challenges are:* This field is required.If not listed here, you can add it to the comment field at the end of this form.

Depression

Bipolar

Anxiety

OCD

ADHD

Autism

Asperger’s

Auditory Processing Disorder

Dyslexia

Learning Disorder

Developmental Delays

Addiction

Brain Injury / Brain Fog

Postconcussive Syndrome (PCS)

Chronic Pain

Insomnia- Sleep-Related Issues

Memory

PTSD

Tinnitus

Have you ever taken any Antidepressants (even for few days) ?* This field is required.This might help with possible Insurance approval

Yes

Have You Ever Taken Any of These Medications, Even for a Day?* This field is required.To Qualify For Insurance Coverage, You Must Have Taken 2 or More of these; Proof Is Not Required. If not listed here, you can add it to the comment field at the end of this form.

Abilify / Aripiprazole

Anafranil / Clomipramine

Ascendin / Amoxapine

Auvelity / Dextromethorphan + Bupropion

Celexa/Citalopram

Cymbalta/Duloxetine

Desyrel / Trazodone

Emsam / Selegiline

Effexor/Venlafaxine

Elavil/Amitriptyline

Fetzima / Levomilnacipran

Geodon / Ziprasidone

Lexapro/Escitalopram

Luvox/Fluvoxamine

Ludiomil / Maprotiline

Nardil /Phenelzine

Norpramin/Desipramine

Pamelor/Nortriptyline

Parnate/Tranylcypromine

Paxil/Paroxetine

Pristiq/Desvenlafaxine

Prozac/Fluoxetine

Remeron/Mirtazapine

Rexulti / Brexpiprazole

Risperdal / Risperidone

Savella / Milnacipran

Serzone / Nefazodone

Seroquel / Quetiapine

Spravato / Esketamine

Surmontil / Trimipramine

Tofranil/Imipramine

Trintellix / Vortioxetine

Viibryd/Vilazodone

Vivactil/Protriptyline

Wellbutrin/Bupropion

Zoloft/Sertraline

Zulresso / Brexanolone

Zyprexa / Olanzapine

Calculation of how many antidepressants taken

We Are In-Network For TMS Services With:* This field is required.We do not accept insurance for any service except to treat depression with TMS. If not listed here, you can add it to the comment field at the end of this form.

Aetna (In-Network)

Anthem (In-Network)

Availity (In-Network)

Beacon - Carelon (In-Network)

Blue Cross(In-Network)

Blue Shield (In-Network)

Blue Shield+Blue Cross (In-Network)

Carelon (In-Network)

Cigna - Evernorth (In-Network)

Evernorth (In-Network)

Healthnet (In-Network)

Humana (In-Network)

Kaiser For Modesto Area Only

MHN (In-Network)

Magellan (In-Network)

Medi-Cal only in Modesto Area (Stanislaus County)

Medicare Starting in November 2025

Optum (In-Network)

Tri-Care (In-Network)

Tri-West (In-Network)

United (In-Network)

Uninsured

Check insurance coverage for these services?* This field is required.

Yes

Would you like to be added to our mailing list?* This field is required.

Yes

Thank you for your interest. Click here to clear your data.

Kaiser coverage is limited to Modesto area Only. Do you within with area?* This field is required.

Yes

Sorry, We Do Not Accept Insurance for the services you listed

We only accept insurance for treatment of major depression using TMS.

Most plans require:

- Diagnosed with Major Depression

- Tried At Least 2 Antidepressants

- Talk Therapy in the Past 6 Months

- 18 or Older (Soon to be 15+)

We are in-network with all commercial insurance plans in California but only for TMS to treat depression.

We will take care of prior authorization and no referral is needed from your doctors.

Would you like to proceed on a self-pay basis? We will provide a detailed, itemized receipt. HSA & Credit Cards accepted* This field is required.

Yes

Would you like to be added to our mailing list?* This field is required.

Yes

Thank you for your interest. Click here to clear your data.

Good news! Your plan may cover depression treatment using TMS. Would you like to schedule your free consultation appointment now?* This field is required.

Yes

Would you like to be added to our mailing list?* This field is required.

Yes

Thank you for your interest. Click here to clear your data.

TMS to treat depression in adults Who have failed to respond to medications, is the only service we accept Insurance for.

Otherwise, all services are self-paid.

Our Fees Start at:

qEEG Brain Imaging $2,995

Treatments: $4,000-$12,000

Please Review Our Fees Before Booking

After reviewing the cost of our services, would you still like to proceed?* This field is required.

Yes

Would you like to be added to our mailing list?* This field is required.

Yes

Thank you for your interest. Click here to clear your data.

How did you hear about us?* This field is required.

Doctor Referral

Google/Search Engine

Family/Friend

Facebook/Instagram/Youtube or other Social Media

Kaiser

County

Past Patient

Thank you for your interest. Check back soon, as conditions do change quickly. Please press SUBMIT and you will be added to our mailing list.

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Appointment Request / Insurance Check