New Patient Intake & Consent Forms

This intake form must be filled out and submitted prior to your first appointment.

How to Get Started as a Patient in My Practice

Our process involves two steps. You can learn more about each of them by clicking the below links.

During this intake the following are assessed:

  • A comprehensive understanding of the current symptoms and problems.
  • A thorough history of present illness including all treatments and efforts to have treated these symptoms in the past, including all therapies, medications, and wholistic practices.
  • A complete psychiatric history of the patient and history of psychiatric illnesses in the family of origin and current family.
  • A complete evaluation of current medical and or health conditions.
  • A complete evaluation of the medications used currently and in the past for the same illness.
    A complete psychosocial evaluation of the current life circumstances, including sources of current mental stress and resources available.
  • A thorough history of suicidality, self-harming behavior, behavior harming others, and any legal history.
  • A complete evaluation on current and history of addictions, alcohol use/abuse, and addiction to self-harming behavior such as eating disorders, sexual and gambling addictions, reckless behavior, and any other potentially harmful coping mechanisms.
  • A complete assessment of sleep hygiene.
  • A complete assessment of sexual health.

The intake is then concluded by creating at least one specific goal for the initial 6-weeks of treatment.

All questions and answers, everything the patient wishes to learn about the modality used, what may constitute psychotherapy homework, and what it takes to be a successful patient in this treatment.

6-week course of treatment (to be repeated until such time that no additional treatments are needed).

During this course, patients will meet face to face with Dr. Dashtban on a weekly basis for one hour and 40 minutes.

During these meetings, the following are expected to happen:

  • Testing of the patients’ mood and anxiety symptoms before and after each session and then over the course of time.
  • An Evaluation of the session in terms of empathy and helpfulness at the end of each session.
  • Ample opportunity to speak and receive empathy and warmth and a place to feel understood and heard.
  • An invitation to work on one or more of the symptoms.
  • An evaluation and assessment of the obstacles that the patient could encounter while trying to overcome certain symptoms.
  • A repertoire of over 100 methods that the patient can practice during the session and then outside of the sessions as homework, that will help reduce or eliminate their symptoms.

How to Begin Goal-Oriented Therapy With Me

You want to get started as soon as possible. That’s why I make beginning evidence-based therapy simple.