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Step 1 of 10

Current Challenges

What symptoms are you currently struggling with? *

How long have you experienced these symptoms? *

What level of impact have these symptoms had on you? *

In a few sentences, tell us a little about your story. Why are you interested in exploring TMS treatment? *

Step 2 of 10

Previous Treatment

Has medication or therapy provided enough relief for you? *

Are you currently working with any mental health providers, therapists, or psychiatrists? *

Step 3 of 10

Financial Access

Would a reduced-cost or free treatment make it possible for you to pursue care that may otherwise be difficult to access? *

Briefly explain why financial support through this fund would be meaningful for you. (optional)

Step 4 of 10

Location and Availability

Which clinic location would be preferable? *

If you are selected, would you be able to travel to one of our clinic locations for treatment? *

Step 5 of 10

Treatment Readiness

Please read the following before continuing.

A 30-minute Zoom consultation with our clinical team is required before any treatment decisions are made. This consultation is free of charge and gives you the opportunity to learn more about TMS, ask questions, and determine whether it is appropriate for you.

A clinician will review your responses and reach out to schedule your consultation after your application is received.

Step 6 of 10

Treatment Information

Please read the following before continuing.

Our offered TMS treatment includes a prescribed single low dose of a medication called D-cycloserine, which has been shown to enhance treatment response. This medication is not an antidepressant and is only administered once.

A clinician will review your medical history and discuss any potential risks or benefits before determining whether it is appropriate for you.

Step 7 of 10

Sharing Your Experience

Some participants may be invited to share private feedback about their experience so our team can better understand and improve the treatment process. This is optional and is not required to receive financial support.

If you are selected, would you be open to sharing private feedback with our team about your experience? *

Would you be open to sharing your story publicly if you felt comfortable doing so? *

Step 8 of 10

Contact Information

First Name

Last Name

Phone *

Email *

City

State

Preferred Contact Method *

Step 9 of 10

Acknowledgments

I understand that submitting this application does not guarantee treatment or financial support. I also understand that a clinical consultation is required before any treatment decisions are made. *

I understand

I understand that Optimal TMS may contact me using the information I provided above. *

I understand

I acknowledge that the information I provide in this application, including health-related information, constitutes Protected Health Information (PHI) under HIPAA. I authorize Optimal TMS to collect, store, and use this information solely for the purposes of evaluating my application, determining treatment eligibility, and contacting me regarding care. My information will not be sold or disclosed to third parties except as required by law or as necessary to provide clinical services. I understand I have the right to request access to my information and to withdraw this authorization in writing at any time by contacting Optimal TMS at [email protected] *

I understand

Is there anything else you would like our team to know?

Step 10 of 10

Acknowledgments Cont.

Before Submitting, Please confirm:

I understand that a Zoom consultation is required. A clinician will review my responses and reach out to schedule your consultation after your application is received.

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Explore the Protocols

Optimal TMS | Las Vegas, NV | Springville, Utah

FDA-Cleared Treatment | Insurance Accepted

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Step 5 of 10

A 30-minute Zoom consultation with our clinical team is required before any treatment decisions are made. This consultation is free of charge and gives you the opportunity to learn more about TMS, ask questions, and determine whether it is appropriate for you.

Step 6 of 10

Our offered TMS treatment includes a prescribed single low dose of a medication called D-cycloserine, which has been shown to enhance treatment response. This medication is not an antidepressant and is only administered once.

Step 7 of 10

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Ready to learn if TMS is right for you?

Optimal TMS | Las Vegas, NV | Springville, Utah

FDA-Cleared Treatment | Insurance Accepted

TREATMENTS

CONDITIONS

COMPANY

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Better. Brighter. Brain.

Optimal TMS 2026 - optimaltms.com - [email protected]

8981 W Sahara Ave, Ste 270, Las Vegas, NV, 89117.- (702) 623 - 1140

382 E 400 S B, Springville, UT 84663 - (725) 344-3322