TMS Consent to Treatment Form

Austin Mind and Behavioral Health

This is a patient consent for a medical procedure called TMS Therapy. This consent form outlines the treatment that Dr. Mohammad A. Khan has prescribed for you, the risks of this treatment, the potential benefits, and alternative treatments available if you decide not to proceed with TMS Therapy.

What is TMS Therapy?

• TMS stands for “Transcranial Magnetic Stimulation.”
• The Apollo TMS Therapy System delivers pulsed magnetic fields using a treatment coil. These magnetic fields are similar in strength to those used in MRI machines.
• TMS is FDA-approved for treating Major Depressive Disorder in patients who have not responded to at least one prior antidepressant medication at an adequate dose and duration.

Treatment Procedure

• Dr. Khan or a trained staff member will place a magnetic coil against the left front region of your scalp.
• Your head will be positioned, and the Apollo system will be calibrated to your individual motor threshold (measured by slight twitching in your right hand).
• The session consists of 4-second magnetic pulses followed by rest periods of 11–26 seconds. Sessions last between 19 and 37 minutes.
• Treatments are usually administered 5 days a week for 4 to 6 weeks (20 to 30 sessions).

What to Expect

• You will remain awake and alert during treatment—no anesthesia or sedation is used.
• You may feel tapping or mild pain at the treatment site, reported by about one-third of patients.
• Headaches occurred in about half of patients during clinical trials but often improved over time and can be managed with over-the-counter medications like acetaminophen.

Important Safety Warnings

The Apollo TMS Therapy System should not be used by patients with:

• Magnet-sensitive metal in or near the head (within 12 inches), including:
  • Aneurysm clips or coils
  • Stents
  • Implanted stimulators
  • Brain-monitoring electrodes
  • Ferromagnetic implants in ears or eyes
  • Bullet fragments
  • Other metal devices or facial tattoos with metallic ink
• Pacemakers or cardioverter defibrillators (ICDs or WCDs)
• History of epilepsy
• History of brain lesions (vascular, traumatic, tumoral, infectious, or metabolic)
• Pregnancy

Additional Considerations

• TMS is not effective for every patient. Worsening depression symptoms should be reported immediately to your doctor.
• Clinical trials show about 1 in 2 patients improve and 1 in 3 achieve full symptom relief with TMS.
• Alternative treatments include medications, psychotherapy, and electroconvulsive therapy (ECT).
• Seizure risk is extremely rare—estimated at 1 in 30,000 treatments (0.003%) or 1 in 1,000 patients (0.1%).
• You must wear hearing protection (rated 30dB+) during each session due to loud clicking sounds.
• Most patients see results by week 4, although timing may vary.
• Relapse is possible without follow-up care; around 30% may need retreatment within a year.
• You may stop treatment at any time.
• You are encouraged to review this information with your physician and family before beginning treatment.

Consent Statement

By signing below, I acknowledge that I have read and understood the information in this consent form regarding TMS Therapy. I have discussed the potential risks, benefits, and alternatives with Dr. Khan, who has answered all my questions. I understand there are other options for treating my depression and that I may discontinue treatment at any time.

I therefore give my consent for Dr. Khan or a member of the TMS Therapeutics staff at Austin Mind and Behavioral Health to administer this treatment.