VNS Therapy™ Suitability Assessment
What country do you live in?
*
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Afghanistan
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eSwatini
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Do you have a diagnosis of Depression or Bipolar Disorder?
*
Yes
No
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Are you currently taking medication, or having some form of therapy (for example, talking therapy, ECT, CBT, TMS, tDCS) to help manage the symptoms of depression?
*
Yes
No
Do you continue to struggle with symptoms of depression despite these medications and other treatments?
*
Yes
No
Including current medications, how many have been tried in total?
*
1-2
3-4
More than 4
Have other non-drug treatments/therapies been tried to manage these symptoms of depression (for example - talking therapies, ECT, CBT, TMS, tDCS)?
*
Yes
No
How open are you to exploring VNS Therapy™ for difficult-to-treat depression?
*
Just doing my research and want to find out more
Actively considering other options such as VNS Therapy™
Ready to talk to my psychiatrist about VNS Therapy™
Already talked to my psychiatrist about VNS Therapy™ but would like more information
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Would you like to receive information about difficult-to-treat depression and VNS Therapy™ that you can discuss with your psychiatrist?
I would like LivaNova to send me additional information about VNS Therapy™ and disease education that I can discuss with my healthcare provider. I consent to use of my medical information for direct marketing purposes and education. I also give permission to be contacted about clinical trials and market research regarding the condition. I understand I can always unsubscribe from direct marketing communications and follow up in accordance with LivaNova’s Privacy Statement.
*
Yes
No
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Name
First Name
Last Name
Email
Eligibility Score
Eligible for treatment
Full Name
Contact Type
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Patient
Caregiver
Patient Age Group
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Child
Teenager
Adult
Patient/Carer
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Readiness Stage
Suitability Assessment Version
Division
Check eligibility
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