Client Screening & Booking Request

Client Screening & Booking Request

Please complete the form to start your booking and background screening process.
Process & Transparency
Before booking can be confirmed, all clients must complete a background screening.
- A non-refundable screening fee is required to initiate this process
- Once your background check is completed and approved, our team will reach out to schedule your service
- Please allow up to 48 hours for screening results (excluding weekends and holidays)
If your background check does not meet our safety standards, services will not be offered.
Safety Standards
For the protection of our staff, Clean Encounters does not provide services in homes associated with:
- Violent criminal history
- Sexual offenses
- Crimes involving harm, exploitation, or endangerment of others
- Any behavior that may pose a risk to our team’s safety or well-being
If you believe your background may fall within these categories, please do not proceed with this request.
Privacy & Confidentiality
Your information is kept strictly confidential and used only for screening and booking purposes. We do not share or sell your data.
Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Current Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Optional notes or additional information
Signature

Screening & Booking Fee

Required to initiate background screening and booking eligibility review

$85.00

Total