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TMS Qualification Form 

Profile Information & Questionnaires

Pre-Qualification form

Fill out this complimentary pre-qualification to receive an in depth understanding of your mental health.

Note: This form is not for a psychiatrist. It will be used to get an understanding of your mental health prior to the TMS Treatment.

Profile Information

All information is kept private. 

Beck's Depression Inventory

Questionnaires

Sadness
The Future
Failure
Satisfaction
Guilty
Punished
Disappointed
Feelings
Thoughts
Crying
Irritation
Interests
Decision Making
Appearance
Motivation
Sleep
Being Tired
Appetite
Weight
Being Worried
Sex

Add up your total score 1-10 ups and downs are normal 11-16 mild mood disturbances 17-20 Borderline clinical depression 21-30 Moderate depression 31 -40 Severe Depression over 40 Extreme Depression. 

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Little interest or pleasure in doing things
no days (0)
several days (1)
more than half (2)
nearly every day (3)
Feeling down, depressed, or hopeless
no days (0)
several days (1)
more than half (2)
nearly every day (3)
Trouble falling asleep/staying asleep/sleeping too much
no days (0)
several days (1)
more than half (2)
nearly every day (3)
Feeling tired, having little energy
no days (0)
several days (1)
more than half (2)
nearly every day (3)
Poor appetite or overeating
no days (0)
several days (1)
more than half (2)
nearly every day (3)
Feeling bad about yourself, or that you are a failure, or have let yourself or your family down
no days (0)
several days (1)
more than half (2)
nearly every day (3)
Trouble concentrating on things (reading, conversations, etc)
no days (0)
several days (1)
more than half (2)
nearly every day (3)
Moving or speaking so slowly that other people could have noticed. Or the opposite; being so fidgety or restless that you have been moving around more than usual.
no days (0)
several days (1)
more than half (2)
nearly every day (3)
Thoughts that you would be better off dead or of hurting yourself in some way
no days (0)
several days (1)
more than half (2)
nearly every day (3)
If you checked off any problem on this questionnaire so far, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?
no days (0)
several days (1)
more than half (2)
nearly every day (3)

Generalized Anxiety Disorder 7 item (GAD-7) Scale 

Please answer Over the last 2 weeks how often have you been bothered by the following

Feeling nervous, anxious or on edge
Not being able to stop or control worrying
Worring too much about different things
Trouble relaxing
Being so restless that it is hard to sit still
Becoming easily annoyed or irriatable
Feeling afraid as if something awful might happen
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