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All clients who wish to enter the clinic must complete this form, wear a mask and sanitize their hands upon entering and exiting the building. We also ask that our clients stand in our designated areas unless otherwise asked to move.
Masks must be worn at all times
Please complete the following questionnaire - If you answer yes to any of the questions you will not be allowed to enter the clinic.
Have you or a member of your household experienced any of the following symptoms within the last 14 days: