If you've never seen a psychiatrist before, the idea of a first appointment can feel opaque. What happens? What do I need to prepare? Will I leave with a prescription?

Here's what actually takes place—and how to get the most out of it.

Before the appointment

Most practices, including mine, will ask you to complete intake paperwork beforehand. This usually covers your medical history, current medications, and what's bringing you in.

Be thorough. The more context I have going in, the more time we can spend on the conversation itself rather than gathering basic information.

If you have records from previous providers—therapy notes, prior psychiatric evaluations, medication trials—bring them or have them sent ahead. I don't need everything, but knowing what's been tried before saves us from reinventing the wheel.

What happens during the evaluation

A psychiatric evaluation is a structured conversation. I'm gathering information, but I'm also observing: how you describe your symptoms, what patterns emerge, how you respond to certain questions.

Expect to cover:

Your current symptoms. What's bothering you now? How long has it been going on? How is it affecting your daily life, work, relationships?

Your history. Previous diagnoses, treatments that helped or didn't, hospitalizations, past medication trials. If you don't remember the name of a medication, "the one that made me gain weight" or "the one that worked but gave me tremors" is useful information too.

Medical and family history. Psychiatric conditions often run in families. Medical conditions and current medications can affect both symptoms and treatment options.

Substances. Alcohol, cannabis, stimulants, caffeine—I need an accurate picture. This isn't about judgment; it's about understanding what's contributing to what you're experiencing and what might interact with treatment.

Your goals. What does better look like for you? Some people want to function at work. Others want to feel less anxious in relationships. Clarity here helps me calibrate what we're working toward.

Will I get a diagnosis?

Sometimes, yes. If the picture is clear, I'll explain what I'm seeing and why.

Other times, the first evaluation raises more questions than it answers. Psychiatric diagnoses aren't blood tests—they're clinical judgments based on patterns, history, and presentation. It can take time to distinguish between conditions that look similar on the surface (depression vs. bipolar II, for example, or ADHD vs. anxiety).

If I'm not certain, I'll tell you that. I'd rather be honest about uncertainty than confident about the wrong diagnosis.

Will I leave with a prescription?

Possibly, but not necessarily.

If there's a clear indication for medication and we agree it makes sense, I may prescribe at the first visit. But medication isn't always the first step. Sometimes we need more information. Sometimes therapy is a better starting point. Sometimes watchful waiting makes sense.

I'll explain my reasoning. You'll have the opportunity to ask questions and push back.

What to ask

Come prepared with questions. Good ones include:

• What do you think is going on?

• What are the treatment options?

• If you're recommending medication, what are the potential benefits and side effects?

• How will we know if it's working?

• What should I do if something feels wrong between appointments?

After the evaluation

You'll leave with a treatment plan—or at least a next step. That might be starting a medication, scheduling follow-up, getting lab work, or connecting with a therapist.

In my practice, I stay directly involved in your ongoing care. You're not handed off to someone else after the first visit. The evaluation is the beginning of a relationship, not a one-time transaction.

Dr. Faisal Rafiq is a psychiatrist offering private, membership-based care in New York. To begin the application process, visit Private Psych MD.