Your First Appointment
What to Expect
Your first appointment—the initial psychiatric evaluation—is the foundation of your treatment. This comprehensive assessment allows us to understand you as a whole person, not just a set of symptoms.
We know that seeing a psychiatrist for the first time can feel anxiety-provoking. Will they judge me? Will they just throw medication at me? Will they actually listen? At RECO Integrated Psychiatry, we approach your first appointment as a collaborative conversation, not an interrogation. Our goal is to understand your experience, identify what's not working, and develop a treatment plan that aligns with your values and goals.
This page walks you through exactly what happens, what to bring, how to prepare, and what comes after—so there are no surprises.
Comprehensive assessment time
Psychiatric, medical, social, family history
Validated assessments (PHQ-9, GAD-7, etc.)
Every patient leaves with clear next steps
The Initial Evaluation Process
Your 90-minute initial psychiatric evaluation follows a structured format to ensure we gather all necessary information while leaving room for your unique story.
1. Chief Complaint & Goals (10 minutes)
What we ask: "What brings you in today?" "What would you like treatment to help with?" "What does success look like for you?"
Why it matters: Your priorities guide treatment. We want to understand not just your symptoms, but how they're affecting your life and what you hope to accomplish.
Example: "I'm here for depression" is a start, but "I want to have energy to play with my kids and feel motivated at work again" gives us clear, meaningful goals to target.
2. History of Present Illness (20 minutes)
What we explore: Detailed examination of current symptoms—when they started, how severe, what triggers them, what makes them better/worse, how they affect your daily functioning.
Key questions:
- When did you first notice these symptoms?
- Have they been constant or do they come and go?
- On a scale of 0-10, how severe are they?
- What makes them worse (stress, sleep, situations)?
- What helps (medications, activities, support)?
- How are they affecting work, relationships, self-care?
- Any suicidal thoughts? Plans? Intent?
3. Psychiatric History (15 minutes)
What we review:
- Prior diagnoses: What have you been diagnosed with before?
- Previous medications: What have you tried? Doses? Duration? Did they work? Side effects? Why did you stop?
- Therapy history: Types of therapy (CBT, EMDR, etc.)? How long? Helpful?
- Hospitalizations: Psychiatric inpatient stays? When? Why? How long?
- Suicide attempts: Past attempts? Methods? When? What led to them?
- Self-harm: Cutting or other self-injury? Current or past?
Why it matters: Knowing what's been tried prevents repeating failed treatments. Understanding what worked guides current treatment. Psychiatric history helps clarify diagnosis.
4. Medical History (10 minutes)
What we ask about:
- Current medical conditions (diabetes, thyroid, heart disease, chronic pain, etc.)
- Past medical conditions and surgeries
- Current medications (all of them, not just psychiatric)
- Allergies and adverse medication reactions
- Recent lab work (thyroid, B12, CBC, metabolic panel)
- For women: pregnancy/breastfeeding status, menstrual cycle effects on mood
Why it matters: Many medical conditions cause or worsen psychiatric symptoms (thyroid disease, vitamin deficiencies, sleep apnea, chronic pain). Medical conditions and medications affect psychiatric medication choices (drug interactions, contraindications).
5. Family History (5 minutes)
What we explore: Mental illness and substance use in blood relatives (parents, siblings, grandparents, aunts/uncles).
Key questions:
- Has anyone in your family had depression, anxiety, bipolar disorder, schizophrenia?
- Any family history of suicide or suicide attempts?
- Substance use disorders in family?
- If they were treated, what medications worked for them?
Why it matters: Mental illness has strong genetic components. Family history helps with diagnosis (bipolar disorder, schizophrenia particularly heritable). Medication response often runs in families—if an SSRI worked for your mom's depression, it's more likely to work for you.
6. Social History (10 minutes)
What we discuss:
- Developmental history: Childhood, family environment, abuse/neglect/trauma
- Education: Highest level completed, learning difficulties, school performance
- Relationships: Marital status, children, relationship quality, social support
- Occupational history: Current work, job satisfaction, work stressors, disability
- Trauma: Physical/sexual abuse, domestic violence, combat, major losses, ACEs
- Substance use: Alcohol, cannabis, stimulants, opioids, benzodiazepines (current and past use, amounts, frequency)
- Legal history: Arrests, incarceration, current legal issues
- Living situation: Where you live, with whom, stability, safety
Why it matters: Psychiatric symptoms don't exist in a vacuum—they're shaped by life experiences, stressors, trauma, and social context. Understanding your background helps us provide trauma-informed, contextually appropriate care.
7. Mental Status Examination (Throughout)
What we observe: The psychiatrist is observing throughout the interview:
- Appearance: Grooming, hygiene, dress, eye contact
- Behavior: Psychomotor activity (agitation, retardation), unusual movements
- Speech: Rate (pressured, slow), volume, coherence
- Mood: What you say you feel ("I feel depressed")
- Affect: What we observe (flat, restricted, labile, congruent with mood)
- Thought process: Linear and logical, or tangential, disorganized, racing?
- Thought content: Suicidal/homicidal ideation, delusions, obsessions, paranoia
- Perceptual disturbances: Hallucinations (auditory, visual)
- Cognition: Orientation (person, place, time), attention, memory, insight, judgment
This isn't a test you can fail—it's clinical observation that provides diagnostic information beyond what you report verbally.
8. Screening Tools (10 minutes)
Validated questionnaires you'll complete:
- PHQ-9: Depression severity (0-27 scale)
- GAD-7: Anxiety severity (0-21 scale)
- PCL-5: PTSD symptoms (if trauma history)
- MDQ: Mood Disorder Questionnaire (screens for bipolar disorder)
- AUDIT: Alcohol Use Disorders Identification Test
- DAST: Drug Abuse Screening Test
- Others as indicated: OCD screening, ADHD rating scales, eating disorder screens
Why we use them: Standardized tools quantify symptom severity, help with diagnosis, provide baseline to track treatment progress, and identify issues you might not spontaneously mention.
9. Diagnosis & Formulation (5 minutes)
What we explain: Your psychiatrist will share their diagnostic impressions based on all the information gathered.
Diagnoses use DSM-5 and ICD-10 criteria:
- Primary diagnosis (the main issue)
- Comorbid diagnoses (co-occurring conditions)
- Differential diagnoses (conditions we're considering or ruling out)
- Contributing factors (medical conditions, substances, stressors)
We'll explain why we arrived at these diagnoses and answer any questions. Diagnosis isn't about labeling you—it's about understanding what's happening so we can choose effective treatments.
10. Treatment Planning (15 minutes)
Collaborative discussion of treatment options:
Medication: If recommended, we discuss:
- Which medication and why (mechanism of action)
- Expected timeline (when you'll notice effects)
- Common side effects and how to manage them
- Starting dose and titration plan
- What to monitor (effects, side effects, safety)
- Alternatives if first choice doesn't work
Psychotherapy: If appropriate, we discuss:
- Type of therapy recommended (CBT, EMDR, DBT, etc.) and why
- Referral to therapist or integrated treatment with psychiatrist
- Expected frequency and duration
Lifestyle and other interventions: Sleep hygiene, exercise, substance use reduction, stress management, support groups
Follow-up plan: When to return, what to do between appointments, when to call
11. Questions & Next Steps (5 minutes)
Your opportunity to ask anything:
- What if the medication doesn't work?
- How long will I need treatment?
- What if I have side effects?
- Can I drink alcohol while on this medication?
- What about pregnancy/breastfeeding?
- Will this show up on drug tests?
- How do I reach you between appointments?
Before you leave, you'll have:
- Clear diagnosis and explanation
- Prescriptions sent to pharmacy (if applicable)
- Follow-up appointment scheduled
- Patient portal login information
- Crisis resources and emergency contact information
- Written treatment plan and instructions
What to Bring
Required Items
- Valid Photo ID — Driver's license, passport, or state ID
- Insurance Card — Both sides, even if we've verified benefits already
- Payment Method — Credit/debit card for copay or self-pay amount
Strongly Recommended
- Current Medication List — All medications (psychiatric and medical), including dosages. Easier to bring pill bottles if you have many medications.
- Prior Psychiatric Records — Records from previous psychiatrists, therapists, or hospitalizations. We can request these, or you can bring them if you have them.
- List of Questions/Concerns — Write down what you want to discuss so you don't forget
Helpful If Available
- Recent Lab Work — Thyroid, B12, CBC, metabolic panel (especially if done in past 6 months)
- Medical Records — From specialists if relevant to psychiatric symptoms (neurologist, endocrinologist, etc.)
- Symptom Journal — If you've been tracking mood, sleep, symptoms
- Past Medication List — Medications tried years ago, responses, side effects
- Family History Information — Mental illness/substance use in relatives, especially what medications worked for family members
Don't stress if you don't have everything. We can work with what you have and gather additional information over time. The most important things are your ID, insurance card, and willingness to share your story honestly.
How to Prepare
A little preparation helps you get the most from your first appointment:
1. Write Down Your Main Concerns
- What symptoms bother you most?
- What would you like treatment to help with?
- What are your goals for therapy/medication?
- What does "getting better" look like for you?
2. Track Symptoms for a Week Before
Note patterns in mood, anxiety, sleep, energy:
- When are symptoms worst? (time of day, day of week)
- What makes them worse? (stress, sleep, certain situations)
- What makes them better? (activities, people, coping strategies)
- How severe on a 0-10 scale?
3. List Prior Treatments
Prevent repeating what hasn't worked:
- Which psychiatric medications have you tried? (even years ago)
- What doses? For how long?
- Did they help? How much?
- Side effects?
- Why did you stop?
- What therapy have you tried? CBT, EMDR, etc.? Helpful?
4. Gather Medical Information
- List of current medical conditions
- All current medications (including supplements)
- Recent lab work if available (thyroid, B12, etc.)
- Relevant specialist evaluations
5. Think About Family History
- Mental illness in blood relatives?
- Substance use disorders in family?
- Suicide in family?
- If relatives were treated, what medications worked?
6. Prepare Questions
Write them down so you don't forget:
- What's my diagnosis?
- What treatment do you recommend and why?
- How long until medication works?
- What are side effects?
- Do I need therapy too?
- What if this doesn't work?
- How long will I need treatment?
7. Be Honest and Thorough
Your psychiatrist can only help if they have accurate information. Don't minimize symptoms or hide important information:
- Suicidal thoughts: Always tell us. We can't help if we don't know. Telling us doesn't automatically mean hospitalization.
- Substance use: We're not here to judge. We need to know to prescribe safely and address co-occurring disorders.
- Trauma: Sharing trauma history helps us provide trauma-informed care. You don't have to share details you're not ready to discuss.
- Medication non-adherence: If you haven't been taking medications as prescribed, tell us why. We can't adjust treatment without knowing the reality.
Everything discussed is confidential (with rare exceptions: imminent danger to self or others, child/elder abuse, court order). You can speak freely.
8. Arrive Early
Allow 10-15 minutes for:
- Parking
- Finding the office
- Checking in
- Completing intake forms (if not done online beforehand)
- Using restroom
- Taking a few deep breaths to settle nerves
Telehealth Option
We offer telehealth (video) appointments for both initial evaluations and follow-up visits. Many patients prefer the convenience and comfort of telehealth.
Benefits of Telehealth
- No travel time or parking hassle — attend from home, office, or private location
- Easier to fit into schedule — no commute means less time away from work/family
- Reduced anxiety — some people feel more comfortable in their own space
- Just as effective — research shows telehealth psychiatric care is as effective as in-person for most conditions
- Just as thorough and personal — full 90-minute evaluation, same assessment process
- Safe and confidential — HIPAA-compliant encrypted video platform
What You Need for Telehealth
- Device: Smartphone, tablet, or computer with camera and microphone
- Internet: Reliable internet connection (WiFi or cellular data)
- Private space: Quiet location where you can speak freely without being overheard
- Good lighting: Face the light source (window, lamp) so psychiatrist can see you clearly
How It Works
- We email you a secure video link before your appointment
- Test the link 10 minutes early to ensure it works
- Click the link at your appointment time—you'll enter a virtual waiting room
- Your psychiatrist will admit you to the video session
- Have your ID and insurance card ready to show on camera
- Complete the evaluation just as you would in-person (90 minutes, same questions)
- Prescriptions sent electronically to your pharmacy after the appointment
When In-Person May Be Preferred
- You prefer face-to-face interaction
- Physical examination is needed
- Certain controlled substance prescriptions require in-person evaluation (varies by state)
- You don't have reliable internet or private space
Discuss with our scheduler which format is best for you. Many patients do initial evaluation in-person then switch to telehealth for follow-ups (or vice versa). You can switch between formats based on your needs.
After Your Appointment
What Happens Next
Diagnosis & Treatment Plan
You'll leave understanding:
- Your diagnosis and what it means
- Why we recommend specific treatments
- What to expect from treatment
- Timeline for improvement
- Next steps
Prescriptions
If medication is recommended and you agree:
- Prescriptions sent electronically to your pharmacy
- Usually available within a few hours
- Instructions for how to take medication
- What to monitor (effects and side effects)
- When to call if problems arise
Therapy Referral
If psychotherapy is recommended:
- We can refer you to therapists we work with
- Or you can find your own therapist
- For complex cases, we provide integrated medication + therapy
- We'll specify type of therapy (CBT, EMDR, DBT, etc.)
Follow-Up Appointment
Scheduled before you leave:
- Timing: Usually 2-4 weeks after starting medication to assess response and side effects
- Once stable: Appointments space to monthly, then every 2-3 months
- Duration: Follow-ups typically 30 minutes for medication management, 45-60 minutes if including therapy
Patient Portal Access
You'll receive login information for our secure patient portal where you can:
- Message your psychiatrist (response within 1-2 business days)
- Request prescription refills
- View visit notes and treatment plans
- Update your information
- Schedule appointments
- Access educational resources
What to Monitor
Your psychiatrist will explain what to watch for:
- Medication effects: Symptom improvement (usually 2-8 weeks for full effect)
- Side effects: What's normal/expected vs. concerning
- Warning signs: When to call immediately (severe side effects, worsening suicidal thoughts, mania symptoms)
- Symptom tracking: Consider keeping a mood journal or using tracking apps
Crisis Resources
You'll receive information about what to do in a mental health emergency:
- Patient portal message: Non-urgent questions (response within 1-2 business days)
- Office phone: (561) 464-4077 for urgent matters during business hours
- 988 Suicide & Crisis Lifeline: Call or text 988 for immediate crisis support (24/7)
- Emergency room: Go to ER or call 911 for life-threatening emergencies (active suicidal intent with plan/means, severe medication reactions, psychotic break)
- Crisis Text Line: Text HOME to 741741 for 24/7 crisis counselor
You're Not On Your Own
Between appointments, you can reach out via patient portal or phone if issues arise. We want you to contact us if:
- Side effects are troublesome or concerning
- Symptoms are worsening despite medication
- You're thinking of stopping medication
- New symptoms develop
- You have questions about your treatment
- You're in crisis
We're here to support your recovery. Don't wait until your next appointment if you need help.
Frequently Asked Questions
How long is the first psychiatric appointment?
Your initial psychiatric evaluation is 90 minutes (1.5 hours). This is significantly longer than follow-up appointments (typically 30 minutes for medication management, 45-60 minutes for therapy). The extended time allows your psychiatrist to conduct a thorough assessment—gathering detailed history, understanding your current symptoms, reviewing medical and psychiatric background, administering screening tools, discussing treatment options, and collaboratively developing a treatment plan. We don't rush initial evaluations. Proper diagnosis and treatment planning require time to understand you as a whole person, not just a list of symptoms. Some patients worry about filling 90 minutes, but most find it goes quickly and appreciate finally having a provider who truly listens and takes time to understand their situation.
What happens during the first appointment?
Your first appointment follows a structured format: (1) Chief complaint—you describe what brings you in and your goals for treatment; (2) History of present illness—detailed exploration of current symptoms (onset, duration, severity, triggers, impact on functioning); (3) Psychiatric history—prior diagnoses, previous treatments (medications tried, therapy, hospitalizations), what helped and what didn't; (4) Medical history—current and past medical conditions, surgeries, medications, allergies; (5) Family history—mental illness and substance use in family members (genetic risk factors); (6) Social history—childhood, education, relationships, work, trauma, substance use, living situation; (7) Mental status examination—psychiatrist observes appearance, speech, mood, thought process, cognition; (8) Screening tools—you complete validated questionnaires (PHQ-9 for depression, GAD-7 for anxiety, etc.) to quantify symptom severity; (9) Diagnosis and formulation—psychiatrist explains their diagnostic impressions; (10) Treatment planning—collaborative discussion of medication, therapy, and other treatment options; (11) Questions—opportunity to ask anything. You'll leave with clear next steps and a treatment plan.
What should I bring to my first appointment?
Please bring: (1) Valid photo ID (driver's license, passport, state ID); (2) Insurance card—both sides, even if we've already verified benefits (we need to scan for records); (3) Payment method—credit/debit card for copay or full payment if self-pay; (4) Current medication list—all medications you're taking (psychiatric and medical), including dosages. If easier, bring pill bottles; (5) Prior psychiatric records—if you've seen other psychiatrists or therapists, records from those providers are helpful (we can request them, or you can bring them); (6) List of questions or concerns—it helps to write down what you want to discuss so you don't forget in the moment; (7) Relevant medical records—recent lab work, imaging, specialist evaluations if they relate to your psychiatric symptoms. Optional but helpful: Journal or symptom tracker if you've been keeping one; List of medications you've tried in the past (even if years ago) and how they worked; Family medical/psychiatric history information if you know it. Don't stress if you don't have everything—we can work with what you have and gather additional information over time.
How should I prepare for my first appointment?
Preparation helps you get the most from your first appointment: (1) Write down your main concerns—what symptoms bother you most? What would you like treatment to help with? What are your goals?; (2) Track symptoms for a week before—note patterns in mood, anxiety, sleep, energy. When are symptoms worst? What makes them better/worse?; (3) List prior treatments—which medications have you tried? What doses? For how long? Did they help? Side effects? This prevents repeating failed treatments; (4) Gather medical information—recent lab work, list of medical conditions and medications, prior psychiatric records if available; (5) Think about family history—mental illness or substance use in blood relatives? This provides important genetic risk information; (6) Prepare questions—write them down. Common questions: What's my diagnosis? What treatment do you recommend? How long until medication works? What are side effects? Do I need therapy too?; (7) Be honest and thorough—your psychiatrist can only help if they have accurate information. Don't minimize symptoms or hide substance use, trauma, or suicidal thoughts. Everything discussed is confidential (except imminent safety risks); (8) Arrive early—allow 10-15 minutes for parking, checking in, completing intake forms.
Can I do my first appointment via telehealth?
Yes, we offer telehealth (video) appointments for initial evaluations and follow-up visits. Telehealth psychiatric care is as effective as in-person for most conditions, with the added convenience of attending from home. Many patients prefer telehealth because: no travel time or parking hassle, attend from comfort of home, easier to fit into work schedule, reduced anxiety about visiting a medical office, just as thorough and personal as in-person. For your telehealth appointment: (1) Ensure you have reliable internet and a private, quiet space; (2) Use a smartphone, tablet, or computer with camera and microphone; (3) We'll send you a secure video link via email before your appointment; (4) Test the link 10 minutes early to ensure it works; (5) Have your ID and insurance card ready to show on camera; (6) Prescriptions will be sent electronically to your pharmacy. Some situations may require in-person visits: if you need physical examination, if medication requires in-person monitoring (controlled substances in some states), if you prefer in-person. Discuss with our scheduler which format is best for you.
What happens after the first appointment?
After your initial evaluation: (1) Diagnosis and treatment plan—you'll leave understanding your diagnosis, why your psychiatrist recommends specific treatments, and what to expect; (2) Prescriptions—if medication is recommended and you agree, prescriptions sent electronically to your pharmacy (usually available within a few hours); (3) Therapy referral—if psychotherapy is recommended, we can refer you to therapists we work with or you can find your own. For complex cases, we provide integrated medication + therapy; (4) Follow-up appointment scheduled—typically 2-4 weeks after starting new medication to assess effectiveness and side effects. Once stable, appointments space out to monthly or every 2-3 months; (5) Patient portal access—you'll receive login information for our secure portal where you can: message your psychiatrist, request prescription refills, view visit notes, update information, schedule appointments; (6) What to monitor—your psychiatrist will explain what to watch for (medication effects, side effects, warning signs requiring contact); (7) Crisis resources—you'll receive information about what to do in a mental health emergency (when to call the office, when to go to ER, crisis hotline numbers). You're not on your own between appointments—you can reach out via patient portal or phone if issues arise.