Patient Consent for TMS Therapy

Patient Consent for TMS Therapy

  • This is a patient consent for a medical procedure called NeuroStar TMS Therapy. This consent form outlines the treatment that your doctor has prescribed for you, the risks of this treatment, the potential benefits of this treatment to you, and any alternative treatments that are available for you if you decide not to be treated with NeuroStar TMS Therapy.

    The information contained in this consent form is also described in the Depression Patient’s Manual for Transcranial Magnetic Stimulation with the NeuroStar TMS Therapy System which is available from your doctor. Not all information in the Manual is stated here, so you should read the Patient Manual and discuss any questions that you have with your doctor. Once you have reviewed the Manual and this consent form, be sure to ask your doctor any questions that you may have about NeuroStar TMS Therapy.
  • Consent

    By initialing the following items, I agree that I understand the following:
  •  Aneurysm clips or coils
     Stents
     Implanted Stimulators
     Electrodes to monitor your brain activity
     Ferromagnetic implants in your eyes or ears
     Bullet fragments
     Other metal devices or objects implanted in the head
  • Date Format: MM slash DD slash YYYY
Living Wage Certification Logo

Proud to be Living Wage Certified Employers

Just Economics of Western North Carolina (JE) is a regional, membership organization based in Asheville, NC. Their Mission is to educate, advocate, and organize for a just and sustainable economy that works for all in Western North Carolina. Click Here to learn more