What to Expect at Your First Psychiatric Evaluation
Updated: 5 days ago
Written by the Prescribed Wellness Psychiatry team · Medically reviewed by Veronica Sanchez, MD · Updated September 2026
A first psychiatric evaluation is a long conversation, not a test. Dr. Sanchez asks about your story, your sleep, nutrition and what's changed recently. You leave with an initial impression and a plan, which may or may not include medication. At our Los Angeles office, that first visit is 50 minutes.
Most people arrive nervous. That's totally normal, and it's worth saying: nobody is going to trap you, judge you, or take anything away from you for answering honestly. The whole point of the visit is to understand what is actually going on, and that only works if you can say true things out loud.
Key takeaways✓ A first psychiatric evaluation is an interview about your symptoms, history, medical health, and daily life. ✓ The American Psychiatric Association (APA) recommends that a first evaluation cover your psychiatric and trauma history, substance use, safety, medical conditions and medications, and cultural background. ✓ There is no blood test that diagnoses depression, anxiety, or ADHD, though lab work is sometimes used to rule out other medical causes. ✓ Not everyone leaves a first visit with a prescription, and starting medication is a decision you make together. ✓ Bringing a written list of your medications, past treatments, and questions makes the visit far more useful. ✓ |
What actually happens during a psychiatric evaluation?
You talk, and the psychiatrist listens and asks follow-up questions. The American Psychiatric Association's Practice Guidelines for the Psychiatric Evaluation of Adults lay out what a thorough first evaluation should cover. That list includes your current symptoms, your psychiatric and trauma history, and past treatments and how you responded to them. It also includes substance use, your medical conditions and medications, your safety, and your cultural background and beliefs about illness.
That sounds like a lot of ground to cover. It is. But it does not feel like an interrogation when it is done well. Most of it comes out naturally once you start describing what has been happening.
How long does a first psychiatric appointment take?
At Prescribed Wellness, a first evaluation is 50 minutes, and follow-up visits are 25 minutes. A first evaluation takes longer than a follow-up because it is covering years of history rather than the last few weeks. Knowing that in advance means you are not watching the clock during the part that matters.
If you are coming from a primary care visit, the difference in pace is usually the first thing people notice. There is time to actually finish a sentence.
What questions will the psychiatrist ask?
Expect questions about when the symptoms started, how often they happen, and whether they are getting in the way of work, sleep, relationships, or things you used to enjoy. Expect questions about alcohol, cannabis, stimulants, and any medication you take that was not prescribed to you. The APA guidelines specifically include substance use, because it changes both the diagnosis and the safest treatment options.
You will also be asked about your family. Not because anyone is assigning blame, but because psychiatric conditions and medication responses often run in families, and that history is useful information.
And you will be asked about your background. The APA guidelines treat cultural factors as a core part of the evaluation, including whether an interpreter is needed and how your own understanding of what is happening shapes the way you describe it. Dr. Sanchez sees this as one of the more important parts of the hour, not a box to check. Visits are available in English and Spanish.
Do I need blood work or lab tests?
Sometimes, but not to diagnose a psychiatric condition. There is no blood test for depression. According to the National Institute of Mental Health, certain medical conditions and medications can produce the same symptoms as depression. Thyroid disorders and viral illness are two examples. A provider can rule these out with a physical exam, an interview, and lab tests.
So labs answer the question "is something else causing this?" rather than "does this person have depression?" Diagnosis still comes from the conversation. NIMH notes that a depression diagnosis requires symptoms most of the day, nearly every day, for at least two weeks. If you already have recent lab results from your primary care doctor, bring them. If a medication we are considering calls for monitoring, we track weight, cholesterol, and blood sugar as part of your care.
Will I leave with a prescription?
Maybe, and maybe not. Some people start a medication at the first visit. Others need more information first, or want to think about it, or turn out to be better served by therapy, a sleep evaluation, or a medical workup. The APA guidelines describe the psychiatrist's job here as explaining the diagnosis and the treatment options, including risks and benefits, and involving you in the decision.
If a medication is part of the plan, it helps to know upfront that psychiatric medications are slow. NIMH notes that antidepressants usually take four to eight weeks to work, and that sleep, appetite, energy, and concentration often improve before mood does. That wait is genuinely hard. It does not mean the medication failed.
NIMH is also clear that people should not stop a prescribed medication on their own, even when they feel better, because a provider can taper it slowly and safely instead. This is worth saying now rather than in month three. Side effects, including weight changes on psychiatric medication, are part of the conversation from the start, not something you have to raise on your own later.
What if I am asked about thoughts of suicide?
You will be. Every good psychiatric evaluation includes it, and the APA guidelines list assessment of suicide risk as a core element of a first visit. The question is asked of everyone, not because of anything specific about you.
Answering honestly does not automatically mean hospitalization. In most cases it means the conversation gets more careful and the plan gets more specific. Saying it out loud is usually the beginning of it getting lighter, not heavier.
If you are in crisis before your appointment, you do not have to wait for it. The 988 Suicide & Crisis Lifeline can be called or texted at 988, 24 hours a day. If someone is in immediate danger, call 911.
Who else finds out what I say?
For an adult patient, generally nobody, without your say-so. Under the HIPAA Privacy Rule, as described by the U.S. Department of Health and Human Services, a provider may share your mental health information with family or others involved in your care when you are given the opportunity and do not object.
There are narrow exceptions. HHS explains that a provider may disclose information over an adult patient's objection in one situation only. There has to be a serious and imminent threat to health or safety, and the person told has to be able to reduce that threat. HHS also notes that a clinician's private psychotherapy notes get stronger protection than the rest of the medical record.
This matters to a lot of our patients, including people whose work involves background checks, employer plans, or a public profile. It is a fair question to ask directly at the start of the visit, and it will get a straight answer. If you work in the industry, our guide to psychiatry near the Burbank and Hollywood studios covers privacy and scheduling in more detail.
For how our office is set up for privacy, see confidential psychiatry in Los Angeles.
How should I prepare for my first visit?
Write down every medication and supplement you take, with the strength if you know it. The APA guidelines include a review of medications as part of the evaluation, and phones die in waiting rooms.
List psychiatric medications you have tried before, roughly when, and what happened. "Made me tired, stopped after three weeks" is useful. "I don't remember the name, it was a small white pill" is still useful.
Note when the current problem started and what else was going on then.
Bring recent lab results or records if you have them, and your insurance card.
Write down your three biggest questions, and ask them even if you run out of time on the rest.
New patients complete intake forms before the first visit. Details on forms and the patient portal are on our current patients page, and the office will walk you through them when you book.
What does a first evaluation look like at our practice?
We are at 3800 Barham Blvd, Suite 416, in the Barham Plaza building at the Cahuenga Pass, with parking in the building. That puts us a short drive from the Burbank lots, Universal City, Toluca Lake, and Studio City, which is deliberate. A lot of our patients are working people who can get to an appointment between call times but cannot spend ninety minutes crossing the city to do it. Visits are in person on Barham Blvd or by secure video anywhere in California.
Dr. Sanchez practices psychiatry rooted in integrative wellness, which in practice means sleep, nutrition, movement, and stress get asked about in the first visit rather than treated as somebody else's department. Medication is one tool among several. You can read more about Dr. Sanchez here.
We are in network with Aetna, Anthem Blue Cross, Carelon Behavioral Health, Cigna, Optum, UnitedHealthcare and Medicare, and provide superbills for out-of-network reimbursement. If you do not have insurance or prefer not to use it, self-pay rates are available with a Good Faith Estimate before your first visit. Coverage varies by plan, so it is worth verifying your benefits before the visit.
Ready to book a first evaluation?
If you have been white-knuckling it for months, that is not a character flaw. It is a reason to get an evaluation. You are also in ordinary company: NIMH estimated that in 2022 about 59.3 million U.S. adults, or 23.1%, were living with a mental illness, and that only about half of them received any treatment that year.
The next step is a single appointment. Request an appointment online or call the office at (626) 681-3729. Common questions about costs and paperwork are answered on our FAQ page.
Insurance, location and booking are on our page for psychiatrists in Los Angeles.
Frequently asked questions
How long does a first psychiatric evaluation take?
At Prescribed Wellness Psychiatry, a first evaluation is 50 minutes and follow-up visits are 25 minutes. A first visit runs longer because it covers your full history rather than the past few weeks: your symptoms, past treatment, medical conditions, medications, substance use, safety, and family history. Plan for a longer visit than a typical primary care appointment.
Is there a blood test for depression or anxiety?
No. There is no blood test that diagnoses depression, anxiety, or ADHD. NIMH notes that a provider may order lab tests along with a physical exam and interview to rule out other causes, such as thyroid disorders, that can produce similar symptoms. The diagnosis itself comes from the clinical conversation.
Will I be prescribed medication at my first appointment?
Not always. Some people start a medication at the first visit, and some do not. The APA practice guidelines describe the psychiatrist's role as explaining the diagnosis, the treatment options, and the risks and benefits, then making the decision with you. Therapy, sleep, and medical workup are sometimes the better first step.
How long do psychiatric medications take to work?
It depends on the medication. NIMH reports that antidepressants usually take four to eight weeks to work, and that sleep, appetite, energy, and concentration often improve before mood lifts. NIMH also advises never stopping a prescribed medication without your provider, who can reduce the dose slowly and safely.
Will my psychiatrist tell my family what I say?
Generally not without your agreement. HHS explains that under HIPAA a provider may share your mental health information with family involved in your care when you have been given the chance to object and have not. Narrow exceptions exist when there is a serious and imminent threat to someone's safety.
What should I bring to a first psychiatric appointment?
Bring a written list of current medications and supplements with strengths, a list of psychiatric medications you have tried before and how you responded, recent lab results or records if you have them, your insurance card, and your three most important questions. Written notes beat memory, especially in a first appointment.
Sources
American Psychiatric Association. Practice Guidelines for the Psychiatric Evaluation of Adults, Third Edition.
National Institute of Mental Health. Depression.
National Institute of Mental Health. Mental Health Medications.
National Institute of Mental Health. Mental Illness statistics, 2022 data.
U.S. Department of Health and Human Services. HIPAA Privacy Rule and Sharing Information Related to Mental Health.
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