Senior & Elder Care

Elder Care Services Agreement

Agreement for elder care and home health aide services covering care plan, schedule, duties, and emergency procedures. Two signers (caregiver and family_member).

📄 2 signers📅 30-day expiry🏷 Senior & Elder Care🔖 two-signers, agreement, healthcare

About this template

The Elder Care Services Agreement is a ready-to-use senior & elder care template you can send for signature in minutes. It is written for 2 signers (caregiver and family member) and, by default, expires 30 days after it is sent if left unsigned. It covers two signers, agreement, healthcare. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.

Document Preview

# Elder Care Services Agreement **Effective Date:** ___________ This Elder Care Services Agreement ("Agreement") is entered into by and between: **Caregiver/Care Provider:** ___________ ("Caregiver") **Family Representative:** ___________ ("Family Member") acting on behalf of the care recipient: **Care Recipient:** ___________ ("Recipient") ## 1. Care Recipient Information **Date of Birth:** ___________ **Address:** ___________ **Primary Physician:** ___________ **Physician Phone:** ___________ **Known Medical Conditions:** ___________ **Allergies:** ___________ **Current Medications:** ___________ **Mobility Status:** ___________ **Cognitive Status:** ___________ ## 2. Scope of Services The Caregiver agrees to provide the following services: **Care Level:** ___________

Fields (41)

effective date
date · required
caregiver name
text · required
family member name
text · required
care recipient name
text · required
recipient dob
date · required
recipient address
textarea · required
primary physician
text · required
physician phone
phone · required
medical conditions
textarea · required
allergies
textarea
medications
textarea · required
mobility status
select · required
cognitive status
select · required
care level
select · required
services
textarea · required
excluded services
textarea
care schedule
select · required
specific hours
textarea · required
overnight
select · required
term
select · required
compensation
text · required
compensation basis
select · required
overtime
select · required
holiday pay
select · required
payment frequency
select · required
payment method
select · required
emergency contact 1
text · required
emergency phone 1
phone · required
emergency contact 2
text
emergency phone 2
phone
medical consent
select · required
medication management
select · required
transportation
select · required
mileage rate
text
background check
select · required
certifications
select · required
termination notice
select · required
governing state
select · required
caregiver signer name
text · required
family member signer name
text · required
relationship
text · required

Related Senior & Elder Care templates

Home Health Aide Services Agreement
Hospice Election & Informed Consent
In-Home Senior Care Services Agreement
Memory Care Admission Agreement
Personal Care / Family Caregiver Agreement
Respite Care Agreement

All 10 Senior & Elder Care templates →  ·  Browse all templates →

Send this template with cryptographic proof

Every signed document gets PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package sealed in WORM storage.

Try the DemoView PricingFounding Member — 50% Off