What to expect at your first adult psychiatry visit

Before the visit

Forms and intake paperwork

A few days before your first visit you'll receive a link to the patient portal with intake forms — basic demographics, medication list, allergies, medical history, and brief screening questions. About 15 minutes. Completing them ahead of time means the clinical visit can focus on actual conversation rather than paperwork.

What to bring

• A list of current medications — including doses and how long you've been on each. OTC supplements and vitamins matter too.
• A list of prior psychiatric medications, if any — what you tried, at what dose, for how long, and why you stopped.
• Records, if you have them. Prior psychiatric notes, prior diagnoses, neuropsych reports, hospitalization summaries.
• Insurance information. Card photo or member ID.
• An honest, working description of what's been going on.

Practical setup for telehealth visits

A reasonably quiet, private space. Headphones help. Good lighting. A device with a working camera. Phones and tablets work fine. We'll send a video-visit link; no app to install.

The first few minutes

The first 2–3 minutes are usually about settling in — confirming audio and video are working, that intake paperwork came through, and that you're physically located in Oregon or Washington. Then the actual conversation begins, usually with some version of "Tell me, in your own words, what brings you in today." There's no right way to answer. Some patients come prepared; others arrive with "I don't even know where to start." Both are fine.

The clinical interview

Current symptoms (15–25 minutes)

What's actually getting in the way day-to-day? When did it start? How is it affecting work, relationships, sleep, eating? What have you already tried? This is the longest portion. The goal is to understand your specific experience.

History (10–15 minutes)

Brief past psychiatric history, past medical history, substance-use history (asked openly, without judgment, because it affects what's safe to prescribe), and brief family psychiatric history.

Developmental history (when relevant)

For adult ADHD evaluation specifically, we discuss childhood patterns. For trauma-related concerns, we may discuss earlier history. We don't dig into childhood for every patient.

Differential screening

Brief questions for conditions that often co-occur with or mimic the presenting problem — depression, anxiety, ADHD, trauma, sleep disorders, substance use, thyroid dysfunction.

Rating scales

• PHQ-9 — depression. Nine items, about 2 minutes.
• GAD-7 — anxiety. Seven items, also about 2 minutes.
• ASRS-v1.1 — adult ADHD. Six items in Part A.
• PCL-5 — trauma-related symptoms, when relevant.

These aren't gimmicks. They're standardized, validated tools that give us a baseline number to track against treatment response — a quantitative way to see whether what we're doing is actually working.

The treatment plan conversation

The last 10–15 minutes are a conversation about what to do next. We discuss what the working diagnosis looks like (sometimes a working hypothesis to test, not yet definitive — we say this out loud), what the treatment options are, the trade-offs of each, and what we'd start with. The plan isn't dictated; it's chosen with your input.

After the visit

You'll usually receive a visit summary in the patient portal within a day or two. If a prescription was sent, it goes electronically to your chosen pharmacy. We typically schedule a follow-up: 2 weeks for new medication starts, 4–6 weeks for dose titration, every few months once you're stable. Between visits, the patient portal is the right place for non-urgent questions — typically returned within one business day.

Common worries before the first visit

"Will what I say be confidential?"

Yes. The visit is protected by HIPAA. Nothing goes to your employer, your school, or your family without your written authorization. Diagnoses don't appear on transcripts or background checks. The standard exceptions are the obvious ones — imminent risk of harm to self or others, mandated reporting situations.

"Will I be judged for what I tell you?"

No. We ask about substance use, sexual history, and prior treatment failures openly because all three change what's safe and likely to work. Honest answers produce better care; we're not interested in moralizing.

"What if I don't have a clear diagnosis?"

Common. Many adults arrive without a clear sense of what's going on; the point of the evaluation is to provide one. Sometimes a single visit isn't enough — we may suggest a brief follow-up. That's normal.

"What if I cry?"

It happens often, and there are tissues. The visit doesn't get shorter or worse if it does.

Frequently asked questions