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.