David flomenhaft 2025

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The document is an intake form for new clients of David Flomenhaft, LCSW, PhD, which collects personal, health, and mental health information necessary for therapy sessions. It includes sections on general health, mental health history, family mental health background, employment status, spiritual beliefs, and insurance details. The form emphasizes confidentiality and outlines the fee policy for services rendered.

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Click ‘Get Form’ to open the david flomenhaft intake form in the editor.
Begin by entering your personal information in the designated fields, including your name, birth date, and contact details. Ensure accuracy as this information is crucial for your first session.
Complete the sections regarding your health history. Answer questions about any previous mental health services and current medications honestly to provide a comprehensive overview of your situation.
Rate your physical health and sleeping habits by circling the appropriate options. This helps in understanding your overall well-being.
Fill out the family mental health history section by indicating any relevant conditions within your family. This can provide valuable context for your therapist.
Review the insurance information section carefully if applicable, ensuring all details are correct for billing purposes.
Finally, sign and date where indicated to authorize the release of information and acknowledge understanding of fee policies before submitting the form.

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