Crestpoint Psychiatric Care (TMS treatment; Intranasal Ketamine)

First Name*

Last name*

Date of Birth*

Email*

Cell Phone Number*

Home Address (Street)*

Home Address (City)*

Home Address (State, Zip Code)*

Insurance Carrier (PRIMARY INSURANCE)*

Member ID*

Who is the person listed as the primary insured?

Self
Spouse
Parent

Full Name and Date of Birth of the primary insured. If this is you, type "self".*

Attach a copy of your insurance card(FRONT)*

Attach a copy of your insurance card(BACK)*

IF APPLICABLE, attach here a COPY of Power of Attorney/Conservatorship letter.

Do you have more than one health insurance carrier?

YES
NO

Is this appointment for Intranasal ESKETAMINE used in the treatment of depression?

YES
NO
Would like to know more

Is this appointment for TMS Transcranial Magnetic Stimulation used in treatment of depression and anxiety?

YES
NO
Would like to know more

Is this visit a request for Psychiatric Consultation/Medication review ONLY?

YES
NO

We will need your Primary Care Doctor to fax a referral to our office. Fax # 423-631-0047

Policy Noted

In a few words, briefly state your reason for this appointment.*

List your ALL your current Psychiatric Medications. If none, type "NONE"*

PLEASE NOTE: Dr. Aimua DOES NOT conduct disability assessments and WILL NOT complete disability paperwork. Dr. Aimua DOES NOT conduct evaluation for Autism Spectrum

Policy Noted

TMS treatment requires you to come into the office daily (5 days a week for 6 weeks). Can you commit to this?

YES
NO
N/A

Intranasal ketamine treatment requires that you MUST have a designated driver who will pick up you from the office after your treatment as you are NOT allowed to drive for 24 hours after each treatment session. Do you have someone that you can designate as YOUR DRIVER?

YES
NO
N/A

Do you have any metal implants (brain clips, brain stent, shrapnel, bullet fragments) in the brain/head or neck area?

YES
NO
N/A

Have you ever had a brain bleed or any blood vessel/bleeding problems?

YES
NO

Do you have a history of epilepsy or seizures?

YES
NO

Name of your Primary Care Doctor and Office Phone Number. If you do not have one, type "None".*

Name of your Therapist OR Counselor and Phone Number. If you do not have one, type "None".*

Scroll down and read through “APPT F.A.Q” section.

Noted

What is TMS?
Transcranial magnetic stimulation (TMS) is a medication-free, non-invasive treatment that uses repetitive magnetic pulses to stimulate nerve cells in the brain to improve symptoms of depression.
During a TMS session, an electromagnetic coil is placed against the scalp.
The electromagnet pulse stimulates nerve cells in the region of your brain involved in mood control and depression.

TMS Therapy is typically used when other depression treatments haven’t been effective.

Transcranial Magnetic Stimulation (TMS) is FDA-approved for Major Depressive Disorder and obsessive-compulsive disorder (OCD). It has fewer side effects than most medications and is twice as effective as most meds.
For most people, the effects are lasting, and they stay depression-free for years to come.

It is covered by MOST INSURANCE, including MEDICARE.

Transcranial magnetic stimulation(TMS) image

Click on the video above to watch Tish's testimonial on how TMS changed her life.

What is TMS (Transcranial Magnetic Stimulation)?

Transcranial magnetic stimulation (TMS) is a non-invasive treatment that uses repetitive magnetic pulses to stimulate nerve cells in the brain to improve symptoms of depression.
During a TMS session, an electromagnetic coil is placed against the scalp. The electromagnet pulse stimulates nerve cells in the region of your brain involved in mood control and depression.¹
TMS Therapy is typically used when other depression treatments haven’t been effective.

Are there any side effects to TMS Therapy?

TMS has few known side effects. The most common side effects are mild scalp discomfort or headaches during treatment, but normal activities can typically be resumed immediately after treatment.

Is TMS covered by my insurance?

TMS is covered by most insurance providers including Medicare (and by Medicaid in some states). Prior authorization is typically required for insurance coverage. Your physician will manage this process. Typically, treatment with antidepressant medications and psychotherapy may be needed before insurance will authorize TMS Therapy.

What does TMS feel like?

The magnetic coil which delivers TMS is positioned on the head. You will hear a clicking sound and feel a tapping sensation on your head when the magnetic pulses are delivered. Many patients watch television or read during treatment.

Who can get TMS treatment?

TMS Therapy is indicated for the treatment of Major Depressive Disorder in adult patients who have failed to achieve satisfactory improvement from prior antidepressant medication in the current episode.

How long will it take for the treatment to work?

This will vary from person to person.
It is commonly reported that patients need 30 to 36 sessions of TMS to feel relief from their depression symptoms. In clinical trials, approximately 58% of treatment-resistant patients responded positively to rTMS therapy.

Is TMS safe?

TMS has over two decades of clinical and scientific research supporting its safe use and application. FDA-cleared for the treatment of MDD, TMS Therapy is an effective, non-invasive, outpatient treatment, with few known side effects.

Who is not a candidate for TMS?

TMS Therapy is well tolerated for most. However, not all patients are appropriate candidates for TMS Therapy.
For example, patients with a history of seizures or who have metal implants or objects in or near their head are not appropriate candidates for TMS Therapy. To determine if TMS Therapy may be right for you, your supervising doctor or psychiatrist will carefully screen for the presence of medical conditions or metal objects which may make TMS unsuitable.

What is the success rate of TMS?

On average, three out of four TMS patients with major depression experience powerful positive effects from TMS, and of those patients, about half experience a complete remission of their symptoms for up to a year after just one course of treatment!

What is ESKETAMINE?

KETAMINE (INTRANASAL ESKETAMINE) Intranasal Spray is indicated, in conjunction with an oral antidepressant, for the treatment of:
**Treatment-resistant depression (TRD) in adults.
**Depressive symptoms in adults with major depressive disorder (MDD) with acute suicidal ideation or behavior. SPRAVATO (esketamine) is the first and only NMDA receptor antagonist approved for 2 subtypes of MDD in adult patients.
SPRAVATO treatment is covered by most insurance companies.

CONTACT THE OFFICE TODAY TO GET STARTED.

Click on the link below for more information regarding SPRAVATO

https://www.spravatohcp.com/sites/www.spravatohcp.com/files/SPRAVATO-Patient-Brochure.pdf?v=257568

https://www.spravatotreatmentcenter.com/sites/www.spravatotreatmentcenter.com/files/SPRAVATO_Dual_Indication_Product_Fact_Sheet.pdf?v=12

Dr. Aimua is board-certified in Psychiatry by the American Board of Psychiatry and Neurology with over fifteen years of clinical experience providing individualized psychiatric care through medication management combined with different psycho-therapeutic interventions to address a broad range of DSM 5 psychiatric syndromes.
Dr. Aimua is an Adjunct Clinical Associate Professor with the ETSU Department of Psychiatry and Behavioral Sciences.

TMS Treatment

Numerous studies have demonstrated the safety and effectiveness of TMS in MDD/OCD/Anxiety, especially in treatment-resistant patients who have not responded to medications. Approximately 58% of treatment-resistant patients respond positively to TMS therapy. CLICK ON THE LINK BELOW TO OUR TMS WEBSITE

Learn More

Psychiatry Services

Dr. Aimua provides psychiatric treatment for various DSM 5 psychiatric disorders using a combined approach of medication management with psychotherapy. Gene-sight Genetic Testing: A pharmacogenomic test that analyzes clinically important genetic variations that may impact how the patient metabolizes and responds to certain medications.

ESKETAMINE Treatment

Dr. Aimua now provides INTRANASAL KETAMINE (SPRAVATO)for treatment for depression. (See below for details)

What should I expect from my first session with the Psychiatrist?

During your first, the Psychiatrist will be asking a lot of questions to try and gain a full understanding of your condition and mental health. It is natural to be anxious about your first meeting but you do not need to be afraid.

Be open about discussing your symptoms. No matter your emotional response to your first psychiatric session, you will find no judgment from your psychiatrist.

It might be easier if you make a list of symptoms that you would like the psychiatrist to know.

The length of the visit varies from person to person. Initial visits are typically scheduled for 1 hour.

Depending on your diagnosis, the Psychiatrist will make treatment recommendations that may include therapy, medications, lifestyle adjustments, and if indicated inpatient treatment.

Can I bring a friend or family member for support?

YES! You will need to sign a consent in the office.

What if I don’t like the Psychiatrist or agree with the recommendations?

If you don't like your psychiatrist, then it is probably best to look for a different mental health provider. It is perfectly normal to not feel comfortable with every Psychiatrist you meet, so don't be afraid to keep looking.

Mental health professionals, like all people, have a wide range of personalities, strengths, and weaknesses, and it's important to find the one who is right for you as an individual.

We are in-network with the following health insurance plans. (Pls note we do not accept TennCare/MEDICAID)

BCBS
UNITED HEALTHCARE/OPTUM
UMR
TRICARE
ANTHEM
MEDICARE
CIGNA/EVERNORTH
AETNA COMMERCIAL
AETNA MEDICARE ADVANTAGE
MUTLIPLAN/IMAGINE 360
MEDCOST
SELF PAY

206 PRINCETON ROAD, STE 18, JOHNSON CITY, TN 37601

+1-423-631-0024 - TEXT: 423-631-0024
423-631-0047 - FAX
crestpp@protonmail.com
OFFICE HOURS Mon: 8am to 4:00pm Tuesday: 8am to 4:00pm Wednesday: TMS/SPRAVATO ONLY Thursday: 8am to 4:00pm Friday: 8am to 12noon

TMS MAGNETIC THERAPY FOR DEPRESSION, OCD, ANXIETY NOW AVAILABLE

Intake form

Transcranial magnetic stimulation(TMS)

TMS Patient testimonial

F.A.Q on TMS

ESketamine (INTRANASAL)

Physician

Services

TMS Treatment

Psychiatry Services

ESKETAMINE Treatment

APPT F.A.Q

What should I expect from my first session with the Psychiatrist?

Can I bring a friend or family member for support?

What if I don’t like the Psychiatrist or agree with the recommendations?

in-network INSURANCE

OFFICE LOCATION