That's completely okay. Many patients are unsure whether they need therapy, medication management, an evaluation, coaching, or a combination of services. Our team can help guide you toward the most appropriate starting point based on your concerns, goals, and circumstances.

Whenever appropriate and desired by the patient, we encourage family involvement and support. Mental health challenges often affect entire families, and collaborative treatment frequently leads to better long-term outcomes.

Yes. When clinically appropriate, family members may work with different providers within our practice. This often allows us to support families in a coordinated manner while maintaining appropriate confidentiality and professional boundaries.

Yes. Many patients benefit from a combination of services such as medication management, therapy, evaluations, life coaching, parent coaching, family therapy, or Spravato treatment. Because our providers work collaboratively, we can coordinate care across services to create a more comprehensive treatment plan.

Yes. One of our core values is collaborative care. When appropriate and with patient consent, our providers coordinate treatment recommendations across medication management, therapy, evaluations, coaching, and family support services to provide a well-rounded supportive experience from multiple viewpoints.

No. At this time, Sulcata Psychiatry does not provide Transcranial Magnetic Stimulation (TMS) or neurofeedback services. If these treatments may be appropriate for your situation, we are happy to discuss referrals to trusted providers in the community.

Treatment duration varies from person to person and depends on symptom improvement, treatment goals, and overall response.

Patients should generally expect:

• Twice-weekly treatments during the first 4 weeks

• Weekly treatments during the second 4 weeks

After the initial treatment phase, treatment frequency is individualized. Some patients continue maintenance treatments long-term, while others gradually increase the time between treatments and may eventually transition to occasional booster treatments as needed.

No. All patients must complete an initial psychiatric evaluation with one of our psychiatric nurse practitioners to determine whether Spravato is clinically appropriate. If enrolled in our Spravato program, your existing psychiatric provider may continue managing your oral psychiatric medications while our team manages your Spravato treatment. However, it is important that you continue to inform us of any oral medication changes made by the outside provider while in our Spravato program.

Ketamine and Spravato are related but not identical treatments.

Spravato is the brand name for esketamine, a specific component of ketamine that has been FDA-approved for treatment-resistant depression and is administered through a structured REMS (Risk Evaluation and Mitigation Strategy) program.

Ketamine is often provided through infusion clinics and may be used off-label for mental health conditions, and is therefore not covered by insurance.

While both treatments affect glutamate pathways in the brain and may be beneficial for depression, they differ in formulation, administration, monitoring requirements, and FDA approval status.

Our Spravato treatment program is currently offered as a cash-pay service. However, the medication itself can be processed through insurance benefits. Please contact our office for current pricing and eligibility requirements.

Unlike many programs that focus solely on medication administration and observation, our model intentionally integrates psychotherapy into treatment by pairing the second hour of treatment with therapy sessions during the early phases of care.

This integrated approach allows patients to process experiences, strengthen therapeutic work, and maximize support throughout treatment. This combination of medication-assisted treatment and therapy is a unique aspect of our program.

Yes. We provide in-office Spravato treatment for qualifying patients experiencing treatment-resistant depression. We require an intake evaluation with a psychiatric nurse practitioner to confirm appropriateness for our Spravato program.

Our life coach is also a diagnostician, Certified Autism Specialist, and has a background in behavior analysis and SpEd services within the Texas public school system. She works extensively with neurodivergent individuals and families, helping bridge the gap between diagnosis and practical day-to-day functioning.

Yes. Parent coaching is available for families seeking diagnostic education and practical strategies to support children with ADHD, autism, behavioral challenges, emotional regulation difficulties, and executive functioning concerns.

Yes. Our life coach is also a Certified Autism Specialist and provides support for autistic individuals as well as education and guidance for families navigating autism diagnoses and related challenges.

Yes. Our certified life coach works with adolescents and adults who have ADHD to improve executive functioning, organization, time management, accountability, and goal achievement.

Therapy focuses on diagnosing and treating mental health concerns, while life coaching focuses on goal achievement, accountability, skill-building, and personal growth.

No. Neither therapy nor medication management is intended to be lifelong for every patient. The length of treatment depends on diagnosis, symptom severity, goals, and response to care. Some patients benefit from short-term, goal-focused therapy, while others may choose longer-term supportive care. Treatment plans are regularly reviewed and adjusted collaboratively.

Therapy frequency depends on your individual needs, goals, and treatment plan. Most patients begin with weekly sessions to establish consistency, build rapport, and address symptoms more effectively. As progress is made, sessions may be gradually spaced out to every other week or on a maintenance basis depending on clinical need and patient preference. Therapy is flexible and individualized. It is not always long-term, and many patients use therapy as a time-limited intervention focused on specific goals or periods of difficulty.

Yes. We provide couples and family therapy services designed to improve communication, strengthen relationships, and support healthier family dynamics.

Prior to beginning couples sessions, each partner meets independently with the therapist for assessment and treatment planning. This helps establish goals and ensure that couples work is appropriate and productive.

Absolutely. Many patients participate in therapy without ever needing psychiatric medication. Therapy can be an effective standalone treatment for concerns such as anxiety, depression, trauma, relationship challenges, stress management, and life transitions.

Yes. We offer a complimentary therapy consultation to help determine whether a therapist is a good fit for your needs before beginning services.

EMDR therapy uses structured techniques to help the brain reprocess memories and experiences that may continue to contribute to emotional distress. Unlike traditional talk therapy, EMDR does not focus primarily on discussing problems in detail or analyzing experiences session after session. Instead, EMDR uses a structured protocol and bilateral stimulation (such as eye movements, tapping, or auditory cues) to help the brain process and integrate distressing memories more adaptively.

While talking is still part of the process, many patients appreciate that EMDR allows them to work through difficult experiences without needing to repeatedly retell every detail of the event. The goal is to reduce the emotional intensity associated with distressing memories and help individuals move forward with greater resilience and emotional well-being.

Yes. All of our therapists are trained in EMDR, an evidence-based treatment approach commonly used for trauma, PTSD, anxiety, and other concerns. Our therapy team includes clinicians with extensive experience treating trauma and PTSD-related concerns.

That's completely okay. Many individuals and families are unsure whether they need an ADHD evaluation, autism evaluation, learning assessment, or another type of diagnostic service.

We offer a complimentary consultation with our diagnostician to discuss your concerns, answer questions, and help determine which evaluation may be most appropriate for your situation. These consultations can be scheduled online through our website.

No. We do not perform court-ordered evaluations, custody evaluations, forensic assessments, disability evaluations, or fitness-for-duty evaluations. If these services are needed, we recommend seeking evaluation from a licensed psychologist or forensic specialist. Our providers will not weigh in on custody disputes or recommendations.

No. Our assessment services focus on ADHD, autism, learning disabilities, executive functioning concerns, and diagnostic clarification for neurodevelopmental concerns.

Because we do not have a licensed psychologist on staff, we do not provide personality testing such as the MMPI, neuropsychological evaluations, forensic evaluations, custody evaluations, or fitness-for-duty assessments. If those services are needed, we are happy to help direct patients to an appropriate provider.

Yes. We provide assessments for learning-related concerns that may impact academic performance, including IQ, dyslexia, dyscalculia, and dysgraphia.

Not necessarily. For many autism evaluations, input from parents or other family members can provide valuable developmental history and additional observations that improve diagnostic accuracy. However, family participation is not required in every situation. The appropriate evaluation process depends on the individual's age, circumstances, and available history. Our diagnostician will discuss recommendations with you before the evaluation.

Yes. We offer comprehensive autism evaluations to help identify characteristics associated with Autism Spectrum Disorder and provide recommendations for support, accommodations, and treatment planning. We utilize the ADOS as part of our comprehensive autism assessments, which is considered the gold standard in autism evaluation.

Absolutely. Many adults, particularly women, are not diagnosed until later in life. ADHD often presents differently in adults than in children and may be mistaken for anxiety, depression, or chronic stress.

Our goal is diagnostic clarity, not simply confirming a diagnosis. Sometimes evaluations identify alternative explanations for symptoms, such as anxiety, depression, executive functioning challenges, learning disabilities, autism spectrum disorder, sleep concerns, or other mental health conditions. We use those results to guide treatment recommendations and next steps.

Possibly. Sulcata Psychiatry may review previous psychological testing records in support of ADHD on a case-by-case basis to confirm and validate diagnosis prior to initiating ADHD medication management. However, you may be required to be re-evaluated by our diagnostician if records do not conform to our testing and timeline policies. This helps ensure diagnostic accuracy and supports individualized treatment recommendations

Yes. At Sulcata Psychiatry, ADHD testing is required prior to ADHD medication management evaluations. We believe objective assessment helps ensure diagnostic accuracy and supports the development of the most appropriate treatment plan.

Yes. Both laboratory testing and urine drug screening will be part of your treatment plan. We will also perform an EKG at your initial evaluation. These policies help ensure safe prescribing practices and support high-quality patient care.

Routine blood work is typically recommended annually to monitor overall health and, when applicable, the safety and effectiveness of certain psychiatric medications. Additional laboratory testing may be ordered more frequently based on your medical history, symptoms, or prescribed medications.

Urine drug screening is a standard component of care for patients receiving controlled substance medications. Testing is typically completed during the initial evaluation and annually thereafter, although additional testing may be required if clinically indicated or if concerns arise regarding medication safety, compliance, or potential interactions.

When clinically appropriate, our psychiatric nurse practitioners may prescribe controlled substances as part of a comprehensive treatment plan, typically once multiple other treatment avenues have been unsuccessful. Not all patients or diagnoses are appropriate for controlled substance treatment, and prescribing decisions are made on an individual basis following a comprehensive evaluation.

Controlled substances require additional monitoring, regular follow-up appointments, and adherence to clinic policies regarding medication management and safety. Non-compliance with these policies may lead to discontinuation of medication at the provider's discretion.

The frequency of follow-up appointments is individualized and determined collaboratively between you and your psychiatric provider based on your diagnosis, symptoms, treatment plan, and medication regimen.

After your initial in-person evaluation, your provider will recommend an appropriate follow-up schedule. Patients who are starting new medications, experiencing symptom changes, or taking certain medications may need to be seen more frequently.

The maximum amount of time between medication management appointments is generally three months. This is particularly important for patients prescribed controlled substances, as state and federal regulations require ongoing monitoring and follow-up.

Yes. While many patients benefit from combining therapy and medication management, treatment recommendations are individualized. Therapy is not required to receive medication management services in most situations. However, if your prescriber determines that your diagnosis will not respond to a medication intervention, they may require participation in therapy as part of your treatment plan.

No. Medication recommendations are based on a comprehensive clinical evaluation by one of our psychiatric nurse practitioners. Not every patient requires medication, and treatment recommendations are individualized based on symptoms, diagnosis, medical history, treatment goals, and patient preference. Our goal is to recommend the least invasive and most effective treatment approach for each individual.

No. Medication management services are provided by psychiatric nurse practitioners. While our providers practice under physician supervision, there is not a psychiatrist physically present in the clinic for appointments.

Medication management is provided by our Psychiatric Mental Health Nurse Practitioners (PMHNPs). Our nurse practitioners are advanced practice providers with specialized training in psychiatric diagnosis and treatment and practice under physician supervision.

Payment plans are not offered for routine services. Payment arrangements may only be considered in specific circumstances involving delinquent accounts to prevent referral to collections.

If an account is referred to collections due to nonpayment, care may be terminated in accordance with the financial policies outlined in the patient consent forms. We encourage patients to contact our office in advance if they have questions about fees or anticipated costs so that financial expectations are clear prior to starting services.

No. Sulcata Psychiatry does not offer a sliding scale for services. Our pricing reflects the structure and expertise required to maintain comprehensive psychiatric, therapeutic, diagnostic, and coaching services under one integrated model.

Finding the right therapeutic or psychiatric relationship is one of the most important factors in successful treatment. If you feel that your therapist or psychiatric provider is not the best fit for your needs, we encourage you to discuss your concerns with us. When clinically appropriate and provider availability allows, we will work to transition your care to another provider within our practice before considering outside referrals. Our goal is always to help you find a provider with whom you feel comfortable, understood, and supported.

Generally, no. Our providers do not routinely participate in legal proceedings or court testimony. If testimony is required through a valid subpoena, provider participation may be required. In those situations, court-related services are billed separately at a rate of $400 per hour, plus travel expenses if applicable. Court preparation time, record review, consultation with attorneys, travel, waiting time, and testimony time are all billable.

Patients may request medical records by submitting a written request to our office staff. While you may download records in Athena, they are typically more limited than what staff is able to manually compile. Once the request is received, our team will compile the records and provide instructions for release. A $20 administrative fee applies to records requests made directly to patients or third parties. However, if records are being sent directly to another healthcare provider for continuity of care, there is no charge. Records can often be transmitted electronically to the receiving provider.

No. There is an important distinction between Emotional Support Animals (ESAs) and service animals.

A service animal is individually trained to perform specific tasks related to a person's disability and is protected under the Americans with Disabilities Act (ADA).

An Emotional Support Animal provides comfort and emotional support but is not individually trained to perform disability-related tasks and does not have the same legal protections as a service animal.

Sulcata Psychiatry may provide ESA documentation when clinically appropriate, but we do not certify, register, or designate animals as service animals.

For established, active patients receiving treatment at Sulcata Psychiatry, our providers may complete Emotional Support Animal (ESA) documentation when clinically appropriate and supported by a qualifying mental health diagnosis. ESA letters are provided at the discretion of the treating provider and require sufficient clinical history to support the recommendation.

We have partnered with Reimbursify to make the submission of Superbills as seamless as possible. If you choose to submit Superbills to your insurance company manually, click HERE for tips on how to fill out claim forms.

Thank you for your interest in working with us! Yes, we are accepting new patients for both diagnosis & medication management appointments, as well as therapy visits. All new patient visits for medication management must be conducted in-person. However, therapy intakes and all types of follow-up appointments may be done via telehealth. We try our best to get patients seen within the same week, but availability is dependent on which provider you are seeing. While you can schedule online, call the office directly for the most accurate availability and wait times, or to be added to the cancellation wait list.

Telehealth or telemedicine services allow you to see the provider via a secure video on your phone or computer for your appointment and receive the same quality services you would normally get in office. We have found that connection via internet on the computer works better than via phone service. We utilize a HIPAA compliant video system called Mend Telehealth. For tips on using Mend, click HERE.

Your treatment starts the moment you contact the office. After determining how we can best assist you, staff will schedule and confirm your initial evaluation. You will receive a confirmation email from Athena, our patient portal service, inviting you to create your own login to view future records.

All intake paperwork can be electronically completed on your phone. A link will be sent out via text message for uploading all required demographic information and completing electronic consents prior to your appointment. Please complete all intake paperwork electronically prior to your appointment to avoid delays once at the office.

Please come prepared with a list of your current medications, including any vitamins/supplements you take regularly. Lab work orders and prescriptions will be sent electronically to your preferred lab and pharmacy locations during the visit if applicable. If you would like us to request previous medical records prior to your Intake visit, you can call staff to obtain an electronic Release of Information (ROI) so that we can request notes from your previous providers.

Sulcata Psychiatry as a clinic is an out-of-network specialty provider with all private insurance companies, as well as Medicaid/Medicare. However, some of our medication management providers have chosen to contract with the Headway platform to accept commercial insurances. Therapy services, diagnostic testing, and academic services are not billed through insurance and are self-pay services only.

Currently, Headway is able to bill Anthem BlueCross BlueShield, Aetna, Cigna, UnitedHealthcare, Oscar, and Oxford. Up-to-date information on which insurances can be processed through Headway can be found HERE. Should you chose to use insurance, you must complete the emailed Headway portal registration to confirm eligibility at least 24 hours prior to your visit or you will be billed at the self-pay rate.

We do accept all FSA and HSA cards. In order to allow for more comprehensive and personal care, our office policy is for patients to pay for their medical services at the time of their visit. We can provide you with a completed claims form ("Superbill") which you may submit to your individual insurance company for reimbursement for self-pay services, based on your specific plan's benefits. Click HERE for our pricing and payment options.

Unfortunately insurance acceptance comes with excessive regulations that can create a barrier to you receiving the care you need. For example, many insurance providers require you to have a referral prior to seeing a specialty provider (including psychiatric care), and many of these clinics have extremely long waitlists to get in. Others will limit the appointment types, treatments, and services you are able to receive - including telehealth.

By not accepting insurance, we are able to provide you immediate access to care with no referral required, longer appointment times when necessary, unlimited appointments based on your needs, and all appropriate treatments no matter your location or distance from our office. However, we do accept FSA and HSA cards, and we also ask for a copy of your insurance card (if applicable) prior to your visit in order to ensure that your medications will be covered at the pharmacy.

Please call or text the office directly for refill requests, or request a refill via the patient portal. Please note we do not prioritize electronic refill requests generated by pharmacies, as they are automatically generated and often inaccurate if medications have recently been changed. We do ask that you call at minimum 3 days prior to needing a refill to ensure that you are able to obtain refills prior to running out of medications, although we do try to process requests within 1-2 business days.

Any new medications will require a patient visit and all controlled substances require a visit at minimum every three months. Please note that refill requests are not considered emergencies, and we will process them as soon as possible during business hours. If you have not been seen within the last 3 months, your refill may be denied or only partially refilled until you are seen for a follow-up.

In all cases of a true time-sensitive emergency - both medical emergency or actively suicidal thoughts - you should dial 911 and/or go to the nearest Emergency Room BEFORE notifying the doctor. You can also dial 988, the mental health emergency hotline to reach a counselor 24/7. Click HERE for further emergency resources.

Please note there is no official on-call service available for Sulcata Psychiatry after hours. We have an Urgent Escalation after-hours option via phone that we try to respond to within 1 hour, but cannot guarantee that response time outside of business hours. All regular messages left after hours will be checked the next business day and will be responded to as soon as possible. Therefore, we ask that you notify us of emergencies AFTER receiving treatment at the nearest hospital or emergency center. Please note that medication refill requests are not considered emergencies.