TMS Consultation form

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Transcranial Magnetic Stimulation Inquiry Form

Thank you choosing MIU Center. Please fill out the details below and we will reach out as soon as possible.

First name*

Last name*

Email*

Phone*

Do you have a history of seizures?*

Do you have a metal plate in your head/body?*

Do you have insurance?*

Are you currently taking illicit drugs or alcohol?*

Are you pregnant or breastfeeding?*

Message*

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