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(407) 986-2888 | alan@azupkacounseling.com

AZupkaCounseling

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Client Forms

If you are new to therapy or counseling, please be sure to fill out the following forms, and bring them to your first session. This will help ease you into therapy and allow as much time as possible to focus on you.

  • Client Contact Information
  • HIPAA Form
  • Mental Health Questionnaire
  • Professional Disclosure
  • Telehealth Doxyme Consent form
  • Good Faith Estimate

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Alan Zupka

Alan Zupka | Counselor | LGBTQ Community | Orlando, FL

(407) 986-2888
alan@azupkacounseling.com

Orlando, FL 32803

"Be proud of who you are and not ashamed of how others see you."
--Anonymous

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Office Hours

Tuesday through Thursday from 11:00 am - 7:00 pm, and Friday and Saturday from 11:00 am - 4:30 pm
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"More will be revealed."
-- Anonymous

Contact Information

Orlando, FL 32803

(407) 986-2888
alan@azupkacounseling.com

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