Senior & Elder Care

In-Home Senior Care Services Agreement

Service agreement between a senior client and a professional in-home care provider covering non-medical personal care, schedule, rates, emergency protocols, and resident rights.

📄 2 signers📅 30-day expiry🏷 Senior & Elder Care🔖 in-home-care, senior, personal-care

About this template

The In-Home Senior 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 (client and provider) and, by default, expires 30 days after it is sent if left unsigned. It covers in home care, senior, personal care. 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

# In-Home Senior Care Services Agreement **Agreement Date:** ___________ **Client:** ___________ ("Client") **Client Date of Birth:** ___________ **Client Address:** ___________ **Authorized Representative of Client (if applicable):** ___________ **Representative's Authority:** ___________ **Provider:** ___________ ("Provider") **Provider Business Name:** ___________ **Provider License/Registration Number:** ___________ **Provider Address:** ___________ **Provider Phone:** ___________ The Client (or the Client's Authorized Representative acting on the Client's behalf) and the Provider (together, the "Parties") enter into this In-Home Senior Care Services Agreement ("Agreement") on the date first written above. ## 1. Services to Be Provided The Provider agrees to furnish the following non-medical personal care and companion services (collectively, "Services"): **Personal Care:** ___________ Bathing, showering, and personal hygiene ___________ Grooming (hair, nails, oral care) ___________ Dressing and undressing ___________ Transfer and mobility assistance

Fields (67)

agreement date
date · required
client name
text · required
client dob
date · required
client address
textarea · required
client rep name
text
client rep authority
select · required
provider name
text · required
provider business name
text · required
provider license
text · required
provider address
textarea · required
provider phone
phone · required
service bathing
checkbox
service grooming
checkbox
service dressing
checkbox
service transfers
checkbox
service toileting
checkbox
service skincare
checkbox
service meals
checkbox
service shopping
checkbox
service housekeeping
checkbox
service transportation
checkbox
service med reminders
checkbox
service vital monitoring
checkbox
service companionship
checkbox
service recreation
checkbox
service appointments
checkbox
additional services
textarea
start date
date · required
service days
select · required
hours per visit
number · required
visits per week
number · required
shift times
textarea · required
overnight care
select · required
schedule notice
select · required
hourly rate
number · required
overnight rate
number
minimum hours
number · required
holiday rate
select · required
invoice frequency
select · required
payment due
select · required
payment methods
select · required
late fee days
select · required
late fee rate
select · required
ltc insurance
select · required
care plan days
select · required
care plan review
select · required
caregiver change days
select · required
supervision frequency
select · required
incident report hours
select · required
advance directive
select · required
emergency contact name
text · required
emergency contact phone
phone · required
emergency contact relationship
text · required
physician name
text · required
physician phone
phone · required
licensing agency
text
liability coverage
select · required
client cancel notice
select · required
short cancel fee
select · required
client notice
select · required
provider notice
select · required
governing state
select · required
dispute county
text · required
dispute state
select · required
client signer name
text · required
provider signer name
text · required
provider signer title
text · required

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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.

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