Collaborate and record You can use this form to return Sooma Therapy records. Please insert your ID: Baseline information: Year of Birth Diagnosis Code(s) Gender —Please choose an option—FemaleMaleOther Handedness —Please choose an option—RightLeftBoth Duration of current episode —Please choose an option—<1 month1-6 months6-12 monthsmore than 1 year Number of past episodes (1) —Please choose an option—01234 or more Treatment resistance (2) —Please choose an option—YesNoUnknown Baseline score Scoring scale Treatment protocol: Treatment type —Please choose an option—Acute treatmenttDCS maintenancerTMS maintenanceECT maintenanceOther Head cap size —Please choose an option—SmallMediumLargeOther Treatments per day —Please choose an option—1Other Treatments per week —Please choose an option—123457Other Treatment weeks —Please choose an option—234681012Other Simultaneous treatments, dosing and changes during the therapy. Post therapy information: Post score Number of completed treatments Please describe effects and/or side-effects of the treatment Treatment was completed successfully —Please choose an option—YesNo If no, why? Consent from the patient to share information Excluding current episode Treatment resistance: inadequate response to at least two antidepressant trial of adequate doses and duration