Cognitive enhancement screening form - The rTMS Centre London

Full Name *

Date of Birth *

Email *

Your Location *

Gender *

Contact Number *

What is your primary reason for seeking TMS for cognitive enhancement? *

Have you tried any other cognitive enhancement tools or techniques before?

Have you ever been diagnosed with a neurological condition (e.g., epilepsy, stroke, brain injury, multiple sclerosis)? *

Do you have any psychiatric diagnoses, past or present? *

Are you currently under the care of a psychiatrist, neurologist, or psychologist? *

Are you currently taking any prescription medications or supplements? *

Do you have a history of head trauma or seizures (even childhood febrile seizures)? *

Presence of electronic implants (e.g. cochlear implant, pacemaker, insulin pump, clips)? *

More information (if required)

Phone