Information
Name
*
Phone
*
Email
*
Questionnaire
1. Have you been diagnosed as having major depression or clinical depression by a professional (psychiatrist, psychologist, social worker, physician)?
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Yes
No
2. Have you been treated with or had significant side effects to at least 4 antidepressants?
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Yes
No
3. Are you being treated for epilepsy?
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Yes
No
4. Do you have any metal in your head (bullets, shrapnel)?
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Yes
No
5. Have you ever been diagnosed with bipolar disorder, schizophrenia, or psychosis?
Yes
No
6. Have you ever been diagnosed with Alzheimers disease or dementia?
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Yes
No
7. Can you sit in a recliner for an hour uninterrupted?
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Yes
No
8. Can you commit to coming daily Monday through Friday 5 days a week for 6 weeks?
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Yes
No
9. Do you have reliable transportation?
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Yes
No
Captcha
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