New Patient Referral Form

Download New Patient Referral Form

Note: This is for patients who are interested in our TMS Clinical Program for depression as well as other neurological indications.

If requesting treatment for depression, form must be filled out in its entirety by the referring Psychiatrist.

If requesting treatment for another neurological indication, form must be filled out in its entirely by the reffering physician.

Once completed, please fax form to 617-975-5322 or email TMSReferrals@bidmc.harvard.edu.

For any questions or more information, please feel free to contact us at 617-667-0307.