Health Canada-approved care pathway

rTMS Referral Form

Use this simple form to request an rTMS consultation for depression or treatment-resistant depression.

Evidence-based
Non-invasive
Psychologist-led care
No emergency or crisis service

Privacy Notice

The information you provide will be used only to respond to this referral or inquiry and arrange appropriate follow-up. Please include only the information requested and avoid unnecessary personal health information.

Not for Emergencies

rTMS is not an emergency service. If this is an emergency or you are in crisis, call 911 or go to the nearest emergency department.

Request a Consultation

Choose the referral option that fits best. Required fields are marked with *.

Self-Referral I am requesting an rTMS consultation for myself. Professional Referral I am a provider referring a patient with consent.

Self-Referral Details

Patient full name *

Patient phone

Phone or email is required.

Patient email

Phone or email is required.

Preferred contact method

City/town

Best times to contact

Presenting symptom(s) or reason for interest in rTMS *

A brief summary is enough. Please do not include medication lists, detailed history, or urgent crisis information.

Thank you. Your referral has been received. Sano State will follow up.