MAGSTIM 3190-00 Operating Manual page 26

The Magstim Company accepts no responsibility for adverse reactions resulting from (TMS) where false or
inaccurate medical information is supplied. Magstim have strict confidentiality policies and we confirm that your
information will be kept securely and will not be passed on to any other third party.
I confirm that I have read and understood the questions above and that my answers are correct and complete to
the best of my knowledge and belief.
PRINT NAME:
SIGN:
DATE:
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Administrator of TMS
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DATE:
© The Magstim Company Limited
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Magstim 2nd Generation Coils
Operating Manual
MOP04-EN-03