Client Service Agreement

Thank you for choosing Grace Home Care Provider. We are honored by the opportunity to provide compassionate, dependable, and personalized home care services for you or your loved one.

Before we begin services, please carefully review the information below. By submitting this request, you acknowledge that you understand and agree to the following terms and conditions.

1. Request for Services

By completing this Service Request Form, you are requesting home care services from Grace Home Care Provider. Submission of this form does not guarantee immediate services. All services are subject to an initial assessment, caregiver availability, and approval by our care management team.

2. Personalized Care Plan

Every client receives an individualized care plan based on their specific needs, health status, personal preferences, and physician recommendations when applicable. Care plans may be updated as your needs change.

3. Caregiver Assignment

Grace Home Care Provider will make every reasonable effort to assign qualified caregivers who best meet your needs. Caregiver assignments may change due to scheduling, availability, emergencies, illness, or other operational requirements.

4. Scheduling

Requested schedules are subject to caregiver availability. We will work closely with you to provide services at your preferred times whenever possible.

5. Client Responsibilities

• Provide complete and accurate information.
• Notify us of any changes to medical conditions, medications, or emergency contacts.
• Provide a safe working environment for caregivers.
• Inform us immediately if scheduled services need to be changed or cancelled.

6. Privacy & Confidentiality

Grace Home Care Provider respects your privacy. Personal information collected through this form will only be used for evaluating, coordinating, and delivering requested services. Information is handled confidentially and shared only when necessary for providing care or as required by law.

7. Medical Emergencies

Grace Home Care Provider provides non-emergency home care services. If you or the client experiences a medical emergency, please call 911 immediately before contacting our office.

8. Communication

By submitting this form, you authorize Grace Home Care Provider to contact you by telephone, email, or text message regarding your care request, scheduling, service updates, and related communications.

9. Accuracy of Information

You certify that all information provided is accurate and complete to the best of your knowledge. Providing false or misleading information may delay or affect the provision of services.

10. Consent & Acknowledgement

By checking the agreement box below and signing electronically, you acknowledge that:

• You have read and understood this Service Agreement.
• You understand that submitting this request does not establish services until an assessment has been completed.
• You consent to Grace Home Care Provider contacting you regarding your request.
• You agree to the terms outlined above.