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Critical Needs Assessment

  1. Please check the services that you feel are needed:

  2. Is there any family/friends who can offer support at this time?

  3. If you are unable to complete this form and/or return to the Senior Center, please call us with your information at 270-4290. You may also fax the form to 270-4296 or email to fitchburgseniorcenter@fitchburgwi.gov

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