Client Forms

Please read and complete the necessary forms before your first appointment. Click on the links to the right to complete the relevant forms.

All Patients

Please use the UPLOAD link below to send us a copy of your insurance card (front and back) and a photo ID.

For ALL NEW patients and follow-up appointments with Dr. Telford, please complete the COVID-19 Patient Questionnaire and Waiver (form 10) prior to each in-person visit. (This is not required for your daily TMS appointments.)

New Patients

Please review and complete forms 1-10. Answer the questions and push submit when complete. Your documents will be sent to us directly and securely. *

If you have any questions or need assistance, please feel free to call us at 907.344.0753. Our staff is happy to help.

* Form 9 is a HIPAA Privacy Notice for your review only and is available to print.

Forms 1-8 are secure Electronic Submission. If you prefer to download the forms, please use the PDF button to the right of each form, fill out, and fax to our office.

1

New Patient Registration Packet

2

New Patient Intake Form

3

New Patient Review of Systems

4

Telemedicine Consent Form

5

ROI-Requesting Entity True North TMS

6

Patient Health Questionnaire

7

Generalized Anxiety Disorder Scale

8

Mood Disorder Questionnaire

9

10

COVID-19 Patient Questionnaire and Waiver

Use the UPLOAD link above to securely send True North TMS your confidential documents and photos.

Please read and complete the necessary forms before your first appointment. Click on the links to the right to complete the relevant forms.

All Patients

Please use the UPLOAD link below to send us a copy of your insurance card (front and back) and a photo ID.

For ALL NEW patients and follow-up appointments with Dr. Telford, please complete the COVID-19 Patient Questionnaire and Waiver (form 10) prior to each in-person visit. (This is not required for your daily TMS appointments.)

New Patients

Please review and complete forms 1-10.
Answer the questions and push submit
when complete. Your documents will be
sent to us directly and securely.

Forms 1-10 are secure Electronic Submission. If you prefer to download the forms, please use the PDF button to the right of each form, fill out, and fax to our office.

Please review and complete forms 1-9. Answer the questions and push submit when complete. Your documents will be sent to us directly and securely. *

* Form 9 is a HIPAA Privacy Notice for your review only and is available to print.

1

New Patient Registration Packet

2

New Patient Intake Form

3

New Patient Review of Systems

4

Telemedicine Consent Form

5

ROI-Requesting Entity True North TMS

6

Patient Health Questionnaire

7

Generalized Anxiety Disorder Scale

8

Mood Disorder Questionnaire

9

10

COVID-19 Patient Questionnaire and Waiver

Use the UPLOAD link above to securely send True North TMS your confidential documents and photos.

If you have any questions or need assistance, please feel free to call us at 907.344.0753. Our staff is happy to help.