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Medical Referrals

Forms and documents

Referring physicians and patients forms.
Physician referral form is to be completed by a physician and faxed directly to Emerald TMS at (541)-735 3455.

  • Physician Referral Form
  • PHQ-9 Questionnaire
  • Patient Intake Form
  • HIPAA 1018

Copyright © 2025 Emerald TMS
1140 Willagillespie Road, Suite 44
Eugene, OR 97401
Office hours: Monday-Friday, 8am-5pm

Phone: 541-735-3241
Text Us: 541-735-3241
Fax: 541-735-3455

Medical Referrals  |  Privacy Policy

Serving:

  • TMS Eugene OR
  • TMS Springfield OR
  • TMS Junction City OR
  • TMS Florence OR
  • TMS Bend OR