You Are Here — Client Intake

Work through each stage in order. Most clients complete everything in about 30-45 minutes.

How This Works

  1. 1. Click a form — it opens in a new window
  2. 2. Fill & sign — everything is electronic, no printing needed
  3. 3. Come back here — continue to the next form
1

Required Forms

2 forms • Must be completed first
MUST BE FIRST

PHI Authorization & Consent

Authorizes us to securely store your personal health information and sign forms electronically.

Complete Form
CONTAINS PHI

Home Care Intake Form

Your main intake form with contact details, emergency contacts, and basic information.

Complete Form
2

Tell Us About You

2 items • Personal

Client Profile

Tell us about yourself before our home visit. Basic info we need to know.

Complete Form

Person-Centered Survey

Tell us who you really are — your favorite foods, daily routines, what makes you happy.

Complete Survey
3

Acknowledgements & Authorizations

6 forms • Review

These forms acknowledge Pennsylvania state requirements, your rights as a client, and confirm you've received important information.

Client Rights DCW Status Financial & Legal Complaints Policy Privacy Practices
Service Agreement After Assessment
4

Care Plan Review

After assessment

After we conduct an in-home assessment, we'll create your personalized Care Plan. You'll review and sign it to begin services.

Care Plan / ISP

Available after your home assessment

Need Help? We're Here For You

Stuck on a form? Have questions? Our friendly team is ready to walk you through every step.

800-719-6912