What to expect at your first ADHD telehealth visit

If you've decided to get evaluated for ADHD as an adult, you've probably already done more research than most clinicians expect. You've also probably noticed that telehealth ADHD care comes in two flavors: clinics that hand out stimulants in five minutes, and clinics that take it seriously. This post is about how the second kind works — specifically, how I run a first visit at Embrace Psychiatry.

Read this if you're considering booking with us, or if you're transferring care from somewhere else and want to know what the handoff looks like.

Before you log in: the paperwork

When you book, SimplePractice sends you a packet to complete before the visit. None of it is optional — finishing it ahead of time is what lets us use the full 60 minutes for the actual conversation. The packet includes:

• PHQ-9 (depression screen)
• GAD-7 (anxiety screen)
• ASRS (Adult ADHD Self-Report Scale — the WHO-validated screening instrument)
• STOP-BANG (obstructive sleep apnea screen). Score ≥3 triggers a sleep-study referral before stimulant initiation
• Medical history — current medications, supplements, surgical history, allergies
• Past mental health history — prior diagnoses, prior medication trials (what worked, what didn't, why you stopped), prior hospitalizations, prior therapy
• Family mental health history — first-degree relatives with ADHD, bipolar disorder, schizophrenia, depression, anxiety, substance use disorders, or completed suicide. This matters more than people realize for medication selection
• Required disclosures — HIPAA acknowledgment, consent to treat, AI documentation consent
• Controlled substance treatment agreement — required for anyone we may end up prescribing a stimulant or other Schedule II–IV medication to. This covers pharmacy lock-in, lost/stolen prescription policy, drug screening agreement, and PDMP authorization

During the visit itself, I'll walk you through the DIVA-5 (Diagnostic Interview for ADHD in Adults) — the structured DSM-5 diagnostic interview I use to confirm or rule out ADHD. This is clinician-led, not something you fill out on your own.

If you don't finish the pre-visit packet, we'll spend the appointment doing paperwork instead of medicine. Get it done.

Strongly recommended: bring your prior records

If you've been diagnosed with ADHD or any other mental health condition before, bring whatever you have to the first visit. Specifically:

• Prior evaluation report (psychiatrist, psychologist, NP, primary care, school psychologist)
• Any neuropsychological testing
• Prior medication list — what you've tried, doses, what worked, what didn't, why you stopped
• Discharge summaries from any psychiatric hospitalization
• Childhood records if available (report cards, IEP/504 plans, teacher comments)

Screenshots, photos, PDFs — whatever format you have works. Upload them through the portal before the visit if you can.

If you have a prior treatment history but the records aren't available, that's fine. We'll sign a release of information at the first visit and request them from your previous provider. No prior treatment history at all is also fine — first-time evaluations are normal and common. Not having records is never a deal-breaker.

The first 60 minutes

ADHD doesn't get diagnosed in fifteen minutes. Not honestly. The DSM-5 criteria require evidence that symptoms started in childhood, that they show up in more than one setting (work, home, school), and that they actually cause impairment — not just inconvenience. Sorting that out takes time, and so does ruling out the conditions that look like ADHD but aren't.

Here's how the time is spent:

1. Chief complaint and current life context (10 min)

What brought you in. What's not working. Work, relationships, sleep, finances, substances, exercise, recent stressors. Where are you living, who's at home, what does a typical week look like.

2. Symptom history + DIVA-5 (15 min)

When did you first notice this? Childhood report cards, parent or teacher feedback, college transcripts if you have them — anything that documents impairment before age twelve. Self-report is fine; collateral is better. If you have any of that, screenshot or photograph it before the visit.

This is also where we work through the DIVA-5 structured interview together. It maps the eighteen DSM-5 ADHD criteria across two life stages (childhood + adulthood) and is the diagnostic backbone of the visit. The ASRS you completed beforehand is a screening tool; the DIVA-5 is the diagnostic one.

3. Differential and screening (15 min)

This is where most quick-script clinics skip. ADHD shares symptoms with — and frequently co-exists with — several conditions, and the treatment for each is different:

• Anxiety disorders — can mimic inattention and restlessness
• Depression — concentration deficits, low energy, anhedonia
• PTSD — hypervigilance, attention issues, sleep fragmentation. Common in veterans and survivors of trauma. Often missed in adult ADHD evals
• Obstructive sleep apnea — daytime cognitive impairment that no stimulant will fully fix. We screen for this with STOP-BANG; score ≥3 triggers a sleep-study referral before stimulant initiation
• Substance use — particularly stimulants, cannabis, and alcohol. Active misuse is a deal-breaker for controlled-substance prescribing
• Thyroid disease, anemia, B12 deficiency — if it's been a while since you've had labs, we may order them

We screen for all of this. If something else is driving the symptom picture, we treat that first.

4. Medical, cardiac, and medication review (10 min)

Stimulants raise heart rate and blood pressure. Before we prescribe one, I need to know your cardiovascular baseline: blood pressure history, family history of sudden cardiac death, any prior cardiac workup, current medications that might interact. If you've ever had a heart attack, we need cardiology clearance before any stimulant. If your blood pressure is unmanaged, we treat that first.

5. Plan and decision (10 min)

We finish with what comes next. There are four possible outcomes from a first visit:

1. Stimulant prescribed — if the picture is clear, PDMP is clean, no red flags, and a controlled substance is the right tool
2. Non-stimulant prescribed — atomoxetine, viloxazine, bupropion, guanfacine, or clonidine, depending on the situation
3. Workup before prescribing — sleep study, labs, cardiology clearance, or records request, depending on what we found
4. A different diagnosis is more likely — and we treat that first

Can you actually get a stimulant on day one?

Yes — if the picture is clear and the PDMP comes back clean.

This is where I differ from a lot of telehealth clinics in both directions. The five-minute-script clinics will prescribe to almost anyone. The hyper-cautious clinics will refuse to prescribe at the first visit on principle. Neither is right for every patient. My rule is straightforward: if the diagnostic picture is clear, the controlled substance is appropriate, and the PDMP shows nothing concerning, we can start treatment that day. If any of those three pieces is uncertain, we slow down.

What I will not do: prescribe a stimulant because a patient pushed for one. The job is to get the diagnosis right and pick the right tool — not to make the visit feel productive.

What gets a "let's slow down"

These don't end the conversation, but they delay prescribing until we resolve them:

• Suspected obstructive sleep apnea — sleep study first
• Active substance use that's affecting the picture — we address that first
• Current stimulant prescription from another provider within the last 30 days — we don't write parallel prescriptions, and we'll coordinate the transfer rather than overlap

What ends the conversation

These are deal-breakers for controlled-substance prescribing. If any of these are present, I will not prescribe a stimulant:

• Active stimulant misuse — non-prescribed use of stimulants, dose escalation beyond prescribed amounts, or recent positive PDMP findings inconsistent with prescribed therapy
• Prior heart attack without current cardiology clearance
• Unmanaged hypertension
• Untreated obstructive sleep apnea
• Suspected malingering — symptom presentation that doesn't hold together

We can still work together on non-controlled options when these are present. We just won't write a Schedule II.

How follow-up works

Follow-up cadence depends on where you are in treatment, not a one-size schedule:

• Newly diagnosed, just starting medication — 2-week follow-up. We check tolerability, side effects, blood pressure, sleep, and appetite. Brief visit, often 15–20 minutes
• Adjusting your dose — 1-month follow-up
• Stable on the same dose — 3-month follow-up. This is the maintenance interval and also the regulatory minimum for ongoing controlled-substance prescribing under Idaho, Washington, Oregon, Nevada, and Arizona rules and current DEA telehealth flexibilities (rules evolve — verify locally)

Between visits, you can message me directly through the patient portal. I respond within one business day. I don't text. I don't take clinical questions on social media.

What you'll probably notice

The thing patients tell me most often after a first visit is that they didn't feel rushed. That they felt heard and respected — not lectured, not pathologized, not treated like they were there to score a prescription. That's not a marketing line; it's the design of the practice. Sixty minutes is enough time to actually understand someone. Fifteen isn't.

If that's what you're looking for, book a visit. If you're not in one of our states yet, hold tight — we're expanding.

— Brandon Kruse, PMHNP-BC, FNP-C

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This article is for general education. It's not a substitute for individualized medical care. Stimulant prescribing decisions depend on a complete evaluation, and rules around telehealth-prescribed controlled substances are subject to change. If you're a current patient with a clinical question, message us through the portal. If you're in crisis, call or text 988.