Become a TMS Patient | CSIP: TMS Center

I certify that the above information is correct to the best of my knowledge and that I have not purposefully misrepresented my health history. I understand it is my responsibility to keep my information accurate and up to date and will notify the office of any changes in health, insurance or contact information. I will not hold my prescriber or any staff member of Collaborative Solutions in Psychiatry, SC (CSIP) responsible for errors or omissions that I may have made in completing this form. I hereby authorize payment directly to my health care provider for all insurance benefits otherwise payable to me for services rendered. I authorize the providers of the office of CSIP to release the information required to secure the payment of benefits. I authorize this use of this signature on all insurance submissions. I understand that the information provided above will be used in screening to determine my eligibility for TMS services. By completing this form, I acknowledge that the TMS Center may find that I do not qualify for TMS.

TMS Center

TMS Screening Form

Patient Information:

Primary Insurance Information:

After submitting this screening form, you will be directed to another link and asked to complete a short survey that captures a current status of your mental health symptoms.

By Completing this Survey,
Our review process will be expedited!

contact us

TMS Screening Form

Patient Information:

Primary Insurance Information:

After submitting this screening form, you will be directed to another link and asked to complete a short survey that captures a current status of your mental health symptoms. By Completing this Survey, Our review process will be expedited!

contact us

After submitting this screening form, you will be directed to another link and asked to complete a short survey that captures a current status of your mental health symptoms.

By Completing this Survey,
Our review process will be expedited!