Sign up for our Patient Registry

Thank you for your interest in joining our patient registry. We are currently gathering information from those who may be interested in future clinical trials. We're developing a minimally invasive device designed to offer new hope for those who haven't found relief with traditional treatments for depression. If you're interested in getting updates on future trials, consider signing up using this form.

Takes about 5 minutes to complete.
Your information is confidential & secure.
By signing up for the registry, you agree to our Patient Registry Privacy Policy.
You must live in the US to apply.

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Step: 1/2: Contact Details

What is your full name?

Where do you currently live?

What city are you from?What state are you from?

What is your email?

What is your phone number?

What is your date of birth?Company website

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Step: 2/2: Medical information

Have you tried two or more antidepressant medications without sustained improvement?

Yes

No

Have you previously received transcranial magnetic stimulation (TMS) for treatment of your depression?

Yes

No

Did TMS reduce your depression symptoms (for any amount of time)?

Yes

No

Briefly explain your experience

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Confirmation page

By clicking the submit button, I confirm I am at least 18 years old and agree to provide the information I provided above to Motif Neurotech for the purpose of being added to the Motif patient registry. I confirm I have read and accept the Motif Privacy Policy and Patient Registry Privacy Policy.

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Thanks for your interest in our clinical trial. We will be in touch soon.

If you need help now please dial 988. Whether you're facing mental health struggles, emotional distress, alcohol or drug use concerns, or just need someone to talk to, 988 has caring counselors that are here for you.

You are not alone. 🫶🏼