Home Care Client Intake Form

Home Care Client Intake Form Template (EDITABLE)

✔️Use this home care client intake form template to ask potential client, or family member to provide information that can help you determine whether the client is a good fit for your services and shape a care plan to address the prospect's needs, interests, and pain points.

This template is great for:

⭐ Home Care Company/Agency

⭐ Personal Care Service/Attendant (PCA)

⭐ Senior Care Business

⭐ Elder Care Business

⭐ Private/Independent Caregivers

⭐ Care Facility

⭐ Volunteer Group

⭐ Non-Profit Organization

How can these form help?

⭐ Focused marketing
⭐ Determine client's pain points
⭐ Filter potential clients quickly
⭐ Quick access to information on file
⭐ Administrative uniformity
⭐ Form repetition saves time
⭐ Assessment dated & documented
⭐ Know what will provide value to client
⭐ Make informed decisions
⭐ Avoid liabilities

Main Features:

✔️ Master File- MICROSOFT WORD DOCUMENT
✔️ Easy to edit forms (editable)
✔️ Insert LOGO/PHOTO
✔️ Ready to convert to fillable forms in Adobe
✔️ Print to PDF
✔️ Send electronically!
✔️ Printable 🖨️

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✔️ Professional non-medical home care templates created by Danielle who owns and operates her own home care business. All templates in the Wise Caregiving Shop have been created from direct hands on experience working with clients, families, care facilities, trustees, curators, and medical professionals. 

✔️ Templates are designed to help non-medical home care business owners get organized, grow, and keep there home care business secure. 

✔️ The templates in the Wise Caregiving Shop are **NOT** allowed to be resold, reproduced, given as freebies, distributed by electronic means, or for customers to profit from the design by any means. 

✔️ All sales are final once files are downloaded from the Wise Caregiving Shop. 

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