Forms

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Thank you for choosing Brain Wellness Center. Following are the forms available on-line.  

 

Intake For all  New Patients

This document includes our initial intake form, depression, and anxiety rating forms. Please make sure you have the Insurance and Costs section, before staring.

 all New Patients please start here 

 

 

 

Weekly Depression & Anxiety Rating Scales (this is for patients receiving TMS or Neurofeedback Therapy)

This document includes our form to assess your weekly Depression and Anxiety.

Weekly Depression & Anxiety Rating Scales

 

 

 

Authorization to Release or Exchange Confidential Medical Information

This document is your permission for us to share your information with someone, or for that person to share their information with us. 

release or Exchange of medical records Authorization

 

 

Bipolar Mood Disorder Questionnaire (MDQ)

This document includes our questionnaire to assess Bipolar Mood Disorder.

Bipolar Mood Disorder Questionnaire

 

 

Legal Forms We need you to sign before treatment

Click below to access the legal forms we use. These will be required once you are given an appointment or accepted to our practice.

Legal Forms

 

 

Adult ADHD Self-Report Scale Symptom Checklist

This checklist includes the self-report symptom scale we use in our treatment of Adult ADHD.

Adult ADHD Self-Report Scale Symptom Checklist

 

 

List of Medications Taken

This document is for your medications you have taken For new patients, this form is already included in the button above  "All New Patients ....".

List of Medications Taken

Patient Success Stories

"I can't say enough good things about Brain Wellness Center and all their staff! Everyone is super friendly and knowledgeable, and they were able to explain everything to me I'm simple layman's terms… 
Jason J.
"I have struggled with depression my whole life, and for those who also suffer from it, you know It not only affects you, but everyone around you. I had tried multiple medications, but they either we… 
Leonard S.
"Brain Wellness Center changed my life from the beginning. At first I was skeptical just like you all probably are, saying that this procedure would have a decrease or a complete recovery from depres… 
Gianella A.