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CLIENT HEALTH SCREENING CHECKLIST
Please answer “Yes” or “No” to each question. Do you have:
Fever (100.4°F or higher), or feeling feverish?
A new cough?
Shortness of breath?
A new sore throat?
New muscle aches?
New loss of smell or taste?
If you have any of the following symptoms, that you can not attribute to another health condition,
please reschedule your appointment to a later date.
- Thank you.
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