TMS Forms

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General TMS Consent Form

This consent outlines the treatment that an Attending Psychiatric Physician will prescribe.

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TMS Patient Registration Form

Patient Registration, Consent for Treatment, Symptoms Checklist, and Various Rating Scales

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HIPAA Notice of Privacy Practices

Integrated Clinical Neurosciences proudly follows all HIPAA and privacy practices. Learn how we protect your rights.

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Assignment of Benefits Agreement

Our policies governing insurance claims. Please agree to the policy before receiving treatment.

Please note: These forms are in Portable Document Format (pdf) and require a pdf reader. If your computer does not have a pdf reader, you may download Adobe Reader X for free here.
Reader X download note: The download is preset to automatically include, for free, both the Google Chrome Internet Browser and the Google Toolbar for Internet Explorer.

These are optional and are NOT required to view and/or print Integrated Clinical Neurosciences/Silicon Valley TMS forms. If you do NOT want them included in your download, be sure to CLEAR the check box called “Yes, install Chrome as my default browser and Google Toolbar for Internet Explorer – optional.(32.11 MB)”.

   

Our practice has officially closed on Friday, January 20, 2023. It has been our privilege to have had the opportunity to meet the healthcare needs for individuals throughout the community.

In California, since the passage of SB-221 which went into effect starting July 2022, health plans and insurances are required to provide timely access to care including follow up appointments for primary care and specialist appointments as well as for other mental health follow-up appointments within 10-15 days. Information is also available at the following link: https://www.dmhc.ca.gov/healthcareincalifornia/yourhealthcarerights/timelyaccesstocare.aspx