TMS Adult Screen

    TMS Adult Screen

    Patient Name
    Date
    TASS Questionnaire
    1. Do you have epilepsy, or have you ever had a convulsion or a seizure?
    2. Do you have a family history of epilepsy?
    3. Have you ever had an EEG?
    4. Have you ever had a stroke?
    5. Do you have any implanted devices such as a cardiac pacemaker, medical pump, or intracardiac lines?
    6. Do you have any hearing problems or ringing in your ears?
    7. Do you have cochlear implants?
    8. Do you have any metal in your head (e.g. shrapnel, surgical clips, metal fragments)?
    9. Did you ever undergo an MRI in the past? If so, were there any problems?
    10. Have you had a head injury (including neurosurgery)?
    11. Do you suffer from frequent or severe headaches?
    12. Have you ever had any other brain-related conditions, fainting spells, or syncope?
    13. Have you ever had any illness that caused brain injury?
    14. Is there any chance you are pregnant?
    15. Do you have an implanted neurotransmitter (e.g. DBS, VNS)?
    16. Did you ever undergo TMS in the past? If so, were there ever any problems?