TMS | Behavioral Treatment | Melville
TMS | Behavioral Treatment | Melville
To Schedule An Appointment
Tel: 631-270-4401 Suboxone :631-513-1672
TMS | Behavioral Treatment | Melville
 
TMS Forms
The following forms are for new patients seeking TMS Therapy. On each form, please fill out as much as you are able to before your scheduled appointment.

NeuroStar Care Connection (NCC) program Brochure Click To Download
TMS Therapy may be covered by your health insurance provider on a case-by-case basis. We can work with the NeuroStar Care Connection (NCC) program to seek coverage from your health insurance provider so you can receive TMS Therapy.

NeuroStar Care Connection Enrollment Form

Click To Download
This form is for insurance approval purposes, Please print out this form and fill out the patient information part to bring to the consulting TMS psychiatrist on the day of your scheduled appointment. The consulting psychiatrist will fill out the remaining before it is sent out to the NeuroStar Care Connection (NCC) program

Patient Privacy Consent Form ( For HIPAA Purpose):

Click To Download
This form entitles Suffolk Behavioral Medicine or its staff to contact the patientís previous physician, therapist and/or any relatives with the patients consent.

Pre-Visit Evaluation Form:

Click To Download
This form is to obtain the patientís personal history, including questions on health, for a comprehensive evaluation

Insurance Information form

Click To Download
This form is for new patients or current patients whose insurance may have changed or expired. Please fill this out and bring it to your scheduled appointment

Clark Financing Brochure

Click To Download
You can also work with Clark Behavioral Health Financing to develop a financing plan, if needed. Please download following Brochure for detailed information

Antidepressant Treatment Record (ATR)

Click To Download
The ATR will clarify and capture patientís eligibility for NeuroStar TMS Therapy
 

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NeuroStar TMS Therapy video
 
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