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TMS Clinic  Form

TMS Clinic Form

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Condition below that applies to your personal medical history and briefly explain in space provided. Diabetes Hypertension High Cholesterol Migraines Chronic Pain Acid Reflux Fibromyalgia IBS Thyroid Disease Heart Disease Head Injury Cancer Seizures Sleep Apnea Stroke Anxiety Depression ADHD Alzheimer s Parkinson s Alcohol/Drug Abuse Name of Hospital Psychiatric Inpatient Hospitalizations Dates of Admission Reason for admission Current Psychiatric Symptoms Please check any symptoms below that...
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