TMS Interest Form

Cedar Park TMS

11901 W Parmer Lane, Suite 310

Cedar Park, Texas 78613

Do you live or work close to our office location in Cedar Park, Texas?

Yes, your office location is convenient for me to get to for treatments.

No ... call us at (512) 265-0429 and we'll see if we can help refer you to another office

Please complete this short interest form below and we'll get back to you as soon as we can during normal office hours Monday - Friday 9am-5pm

First Name *

Last Name *

Phone *

Email *

Main Concerns:

Depression

Anxiety

Stress

Do you have behavioral Health Insurnace you like to use, or do you need information about self-pay rates?

Questions or Comments ...

I authorize you to reach out to me ...

This information is kept private and only seen by the Cedar Park TMS staff & supervising Psychiatrist Dr Brian Earthman.

We will reach out to you as soon as possible during our normal office hours M-F 9am-5pm.

You're also welcome to call or text us at (512) 265-0429.

We look forward to talking with you.

Amy Earthman - Office Manager