Schedule an evaluation

For health professionals

In order to refer your patient for TMS treatment at UCLA, please download and complete this referral from and fax it to us at 310.825.7642, or email us at
To refer a patient via Care Connect, please follow the instructions here.

Referral Form (click to download)

Care Connect Referral Instructions (click to download)

For patients

TMS treatment at UCLA requires a referral from your health care provider. Your current provider should fill out this referral form and fax it to our offices at 310.825.7642, or email it to Please also complete this record release form and give this to your provider so that he or she can provide information on your past treatments to us for this evaluation.

Release Form (click to download):