Clearance, readiness & fitness assessments
Certain medical procedures, regulatory requirements, and high-stakes roles require a focused psychiatric evaluation — not for ongoing treatment, but to assess readiness, stability, insight, adherence potential, and the risk factors that could affect safety or outcomes. These evaluations answer a specific referral question and produce a clear, usable report for the requesting party: a surgeon, transplant team, aviation medical examiner, employer, licensing board, agency, or the VA.
Four categories of evaluation
We provide structured, evidence-informed psychiatric evaluations in four categories. Each one is tailored to the specific referral question and to the guidelines, protocols, or evidentiary standards that govern it, and each ends in a focused written report the requesting party can actually use — clear findings, clear recommendations, and answers to the questions that were asked.
Presurgical & pre-procedure
Psychological readiness for bariatric surgery, organ transplant, spinal cord stimulators, DBS, LVAD, and other procedures and implants — contraindications, insight, adherence risk, coping resources, and support systems.
Occupational & regulatory clearances
Fitness for duty, FAA special issuance, and return-to-practice evaluations for roles where mental health stability and cognitive reliability are critical to public safety or professional standards.
Capacity, guardianship & specialized
Medical decision-making capacity, guardianship, firearm permit, and pre-adoption evaluations — each structured around the standard the court, agency, or treating team has to apply.
VA nexus letters & DBQs
Independent psychiatric opinions and completed Disability Benefits Questionnaires for veterans' disability claims and appeals — built on a records review, a full clinical interview, and the reasoning the VA actually weighs.
What these evaluations involve
The referral question
We start from what the requesting party actually needs answered, and from the protocol, guideline, or form that governs it — a transplant program's criteria, an FAA pathway, a board's evaluation form, a statutory capacity standard. Records sent in advance are reviewed before the interview, not after.
The evaluation
A comprehensive clinical interview, a targeted review of records, and assessment of relevant psychiatric history and current functioning — plus evaluation of insight, adherence potential, and expectations, and standardized measures when indicated. The scope matches the question, and stops there.
The written report
A focused report to the requesting party with clear findings and recommendations, written to address the precise questions that need answering — in the format, or on the form, the referring entity requires.
Who we evaluate — and who refers
Presurgical & pre-procedure psychological evaluations
Bariatric surgery, an implanted device, a transplant — many programs require psychological clearance before proceeding, because readiness, insight, and adherence measurably affect outcomes. We evaluate for the full range of procedures and report directly to your program.
- Bariatric / metabolic weight-loss surgery
- Spinal cord stimulators & other neuromodulation devices
- Solid organ transplant candidacy & living donors
- Deep brain stimulation (DBS) & LVAD candidacy
- Egg / sperm donor & gestational carrier evaluations (ASRM-aligned)
Occupational, regulatory & safety-sensitive clearances
Fitness for duty, special issuance, and return-to-practice — evaluations for roles where mental health stability and cognitive reliability are critical to public safety or professional standards. Licensing-board, monitoring-program, FAA SSRI special issuance, and return-to-practice evaluations are covered in depth on our professional evaluations page.
- Pre-employment and fitness-for-duty evaluations for public safety roles — police, firefighters, corrections, and certain federal law enforcement positions
- Military aviation and flight-physical related psychiatric assessments
- Evaluations for other high-reliability industries on request, including selected nuclear, transportation, and safety-critical roles
Capacity, guardianship & other specialized evaluations
Focused evaluations for decisions that turn on a psychiatric or cognitive question — each structured around the specific standard the court, agency, or treating team has to apply.
- Medical decision-making capacity and capacity-to-consent evaluations, where psychiatric or cognitive concerns arise around a major procedure or treatment decision
- Guardianship evaluations
- Firearm / gun permit psychological evaluations, where required by state law
- Pre-adoption psychological assessments, when requested by an agency or jurisdiction
VA nexus letters & disability benefits questionnaires (DBQs)
A VA disability claim needs more than a diagnosis — it needs a reasoned medical opinion connecting the condition to service. We write independent nexus letters and complete DBQs built to carry that weight.
- Nexus letters with the clinical rationale spelled out
- Disability Benefits Questionnaires (DBQs) for mental health conditions
- Secondary service connection & aggravation opinions
- Second opinions after a denial or a thin C&P exam
The goal is objective assessment and documentation that supports safe, informed decision-making by the medical team, regulator, employer, agency, or the VA. An evaluation doesn't establish ongoing psychiatric care, and its findings belong to the referral question rather than to a treatment plan. If treatment is indicated, we say so in the report — and we can discuss it with you separately.
Referrals and self-referrals are both accepted
Tell us the specific type of evaluation requested, and send whatever governs it. The more we have up front, the more efficiently the evaluation can be completed — and the more precisely the report can address the questions that actually need answering.
Not sure whether the evaluation you need falls within the scope of services offered? Contact the office and ask. We'll tell you plainly, and point you elsewhere if we're not the right fit.
- The specific type of evaluation requested
- Any governing guidelines, protocol, or forms required by the referring entity — including the VA's DBQ for your condition
- Relevant medical, psychiatric, or program records
- Your deadline, and who the report should be sent to
Don't have all of it yet? Send what you have — we'll tell you what else the evaluation needs.
How billing works
Specialized evaluations are private-pay, billed at an hourly rate that covers records review, the evaluation itself, collateral interviews, and report-writing time — quoted in advance on the factors above. Evaluations required by a third party (a program, regulator, employer, board, court, or the VA) are generally not billable to health insurance. Some presurgical evaluations are billable when the procedure itself is a covered benefit; we check your plan and tell you which situation you're in before we start. If treatment follows the evaluation, that's separate — we're in-network with major insurers for ongoing psychiatry and therapy. Call (888) 730-5220 to talk it through.
Ask about billing
Common questions about Specialized evaluations
Can these evaluations be done by telehealth?
Who sees the report?
How long does it take to get the report?
How much does an evaluation cost?
Does insurance cover a specialized evaluation?
Do I need a referral, or can I request an evaluation myself?
Request a specialized evaluation
Tell us the type of evaluation you need and who the report is for. Send any governing forms and records in advance, and we'll schedule around your deadline.
Request an appointment