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Client Prescreening Form
Due to the ongoing Covid-19 pandemic, we are taking precautions to ensure the safety of our staff and clients. Please read, date and sign the following certification statement prior to the start of your service.


I, Cassandra Moore, have not been quarantined within the last 14 days due to Covid-19 symptoms or illness,  and I am not showing symptoms today.   *
Cassandra Moore
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Cassandra Moore *
08/24/2021 *
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