Please note - Only use these forms if you reside in any of the states below:
The Patient Intake(PI) process is self-guided. Once you fill out the form on this page, you will be taken to a secure page (Step 1). Step 2 is the PI form itself, and is a single document with three parts. When your completed PI Document has been submitted, you will have safely and securely provided TMS Solutions with the information necessary to start you down the road to TMS Therapy Treatment.
STEP 1: Create Your Account
You'll first begin by creating an account in a safe, secure, encrypted, HIPAA-compliant platform hosted by Formsite®. You'll be able to log in; this way if you need to stop to get additional information, health or medical records, you can save your work and pick up where you left off when you return.
STEP 2 -- The Patient Intake Form in Three Parts:
Part I – HIPAA Consent
Before we can gather any personal information from you, we need your consent to do so. This form explains your rights and our responsibilities when it comes to your protected health information.
Part II – Personal Information
- Patient Information – To fill this in you'll need your personal basic information and an emergency contact's information.
- Healthcare Professional Information – You'll want the contact information for each healthcare provider you are currently seeing for your mental health.
- Insurance Information – We need this to check the benefits your current insurance plan has for TMS Therapy
- Health History – You'll need medications, dates for treatments, etc. If you have this on hand, you'll fly right through this, versus having to stop, look for information and start again. You may time out on the form if you don't have this readily available. While you should be able to use the return link, if you have an issue getting back in, call your Patient Advocate at 844-537-6747 for assistance filling out the form.
Part III – PHQ-9
This ten question self-assessment provides you and TMS with a baseline indication on your current mental state.
Once You've Completed the Patient Intake Form, Here's What Happens Next:
- Within a business day of completing the Patient Intake Form, you will receive an email invitation to register for our electronic medical records system, in our Kareo® Patient Portal (Different from your Formsite Account). We will use this private, HIPAA-compliant platform to keep you updated on the progress of your benefits investigation and insurance authorization process.
- Your Patient Advocate will review your responses and contact you if any additional information is required, or clarification is needed.
- The process to determine if your insurance will cover TMS Therapy consists of two parts:
- The Benefits Investigation (BI). This is where we determine if you have insurance benefits that will cover TMS therapy. This will typically take one business day. We will then call you to discuss these results and make sure that you are comfortable with your financial obligations should you decide to pursue therapy.
- Prior Authorization. Once we receive your consent to pursue authorization for treatment, your TMS Care Team will submit a Prior Authorization Request to your insurance company on your behalf. This process typically takes 3-10 business days. Please note: As each person’s situation is different, sometimes this process can stretch out longer, but we promise to keep you informed all along the way.
- Upon authorization determination, a member of your TMS Care Team will call you to schedule your first appointment.
Thank you for putting your healthcare needs in our hands. We are honored and excited to be a part of the process for your healing from depression.
Your TMS Care Team