216-752-9090
First time visiting? Be sure to fill out the forms below. You can fax them over to 216-752-9080, print & scan, or bring them in on your first visit.
I plan to self-pay
I plan to use Tricare
I plan to use Medicare, Medicaid, or Commercial insurance
I plan to pursue Spravato Treatment
Informed Consent Form - Part 1
Informed Consent Form - Part 2 - Screening Questionnaire
Patient Health Questionnaire
Billing and Payment Agreement
Adult TMS Registration
TMS Therapy Exclusion Criteria
Medication Checklist
Consent to Release Information
TMS Patient Consent
HIPPA Notice
HAM-D
New Patient Referral Form
Spravato Patient Enrollment Form