WE’RE GLAD YOU’RE HERE.
Start your mental health journey with Acacia.
TMS INTAKE PAPERWORK
We are glad you have chosen to learn more about TMS. Reaching out can often be the most difficult step. We commend you for taking this step and are here to support you throughout the intake process.
There are a few intake forms to fill out before your appointment. Please scroll through this page to access all of the forms. There are four required forms.
After receiving your intake paperwork, a member of our TMS coordination team will reach out shortly to schedule your appointment. You can also call us at (650) 521-5211 to schedule an appointment.
TMS Intake Paperwork
Required 1 of 4
Release of Information (ROI)
Required 2 of 4
Mood Survey: QIDS
Required 3 of 4
In order to make the best assessment for your care, our doctors would like to know a bit more about how you’re feeling. Please complete this form on our HIPAA-Secure site.
Mood Survey: BDI
Required 4 of 4
In order to make the best assessment for your care, our doctors would like to know a bit more about how you’re feeling. Please complete this form on our HIPAA-Secure site.
Financial Aid
Optional
We understand finances can be difficult. Please fill out this form to be considered for financial aid.