To enroll in the Connections program and receive more information on VNS Therapy for the treatment of chronic or recurrent depression , please fill out the information listed below in as much detail as possible. This will help us send you the materials that would best suit your needs.

If you do not live in the United States, please go to our International website for more information.

If you have already enrolled in the Connections Program and would like a copy of the Portraits of Hope, please call a Cyberonics' Case Manager at 877-NOW-4VNS.

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How did you find out about the VNS Therapy Web site?

Are you a patient or a friend/family member?* (Required)

Patient Enrollment Form

When were you first diagnosed with depression?

How many different medications have you ever taken for your depression?

On a scale of 1 to 5, with 1 being "not very severe" and 5 being "very severe," how would you rate your current level of depression?

Having depression has severely restricted by life.

I feel like I’ve tried just about everything to treat my depression and there is nothing that works.

On a scale of 1 to 5, with 1 being "not very satisfied" and 5 being "very satisfied," how would you rate your current level of satisfaction with your current antidepressant treatment regimen?

Has your psychiatrist ever recommended that you consider VNS Therapy as a potential long-term treatment option for your depression?

I rely solely on my psychiatrist’s recommendations.

I’d rather have my psychiatrist make the decisions about what is best for me rather than have him/her give me a lot of choices.

I ask my psychiatrist about treatments I see advertised on TV.

Some depression actually resist treatment.  If your depression has not completely responded to 4 or more treatments, or if your depression comes back over time, you may be experiencing Treatment-Resistant Depression.

From the list of statements below, please select the statement you feel best describes how the previous description applies to you.

Terms and conditions
By submitting this information, you agree to the Cyberonics Terms and Conditions for use of this information. Please fill out the information listed above to the best of your knowledge. You do not need to answer all the questions to enroll in the Connections program.

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