Review Service Agreement
This agreement outlines the structure, expectations, and communication for Peace of Mind Care Visits.
Please take a moment to review the Service Agreement & Disclosures before proceeding. Confirmation of receipt is required below. Thank you!!!
Peace of Mind Care Visits Service Agreement & Disclosures
Intro
Our goal is to provide consistent, supportive, non-medical visits that help individuals feel comfortable and families feel informed.
Services Provided
Peace of Mind Care Visits provides non-medical, in-home wellness and safety visits. Services may include:
Regular check-ins and in-home presence
Conversation and companionship
Observation of general well-being
Home safety awareness
Communication with designated contacts (with permission)
Services Not Provided
Peace of Mind Care Visits does not provide:
Medical care or clinical services
Medication management
Personal care or assistance with activities of daily living (ADLs)
Transportation
Emergency response services
Housekeeping or cleaning services
Meal preparation or chef services
Pet care or pet-related services
Non-Medical Role
Peace of Mind Care Visits is a non-medical service. Observations are general and non-clinical.
Any concerns identified during a visit will be communicated to the designated contact but do not constitute medical advice or diagnosis.
Emergency Protocol
In the event of an emergency, 911 will be contacted immediately.
The designated primary contact will be notified as soon as possible following emergency response.
Visit Scheduling
Visits are scheduled in advance based on agreed-upon frequency and availability.
Visits are not confirmed until payment has been received.
Adjustments may be made as needed and will be communicated in advance whenever possible.
Communication
Updates will be provided to the designated contact(s) following visits, based on preferences established during intake.
Communication is intended to provide general updates and observations.
Payment & Terms
Services are private pay. Payment structure and visit frequency will be confirmed prior to the start of services.
Visits are not confirmed until payment has been received.
All sales are final. Payments are non-refundable except in the case of provider cancellation.
Ongoing or subscription-based services require 30 days’ written notice for cancellation to allow for scheduling adjustments.
Cancellation & Rescheduling
At least 24 hours’ notice is required for cancellations or rescheduling and must be submitted in writing.
Late cancellations or rescheduling requests will be considered a completed visit and are non-refundable.
Access & Entry
The client or responsible party is responsible for providing accurate and up-to-date access information for each visit, including but not limited to gate codes, entry instructions, or facility requirements.
Peace of Mind Care Visits is not responsible for delays or missed visits due to incomplete or incorrect access information.
If access cannot be obtained at the scheduled time, the visit may be considered completed.
It is the responsibility of the client or responsible party to ensure all necessary permissions for entry into residences, communities, or facilities are in place prior to scheduled visits.
Missed or Unavailable Visits
If the individual is not present, does not answer, or declines the visit at the scheduled time, reasonable efforts will be made to contact the designated primary contact.
If the visit cannot be completed as scheduled, it will be considered a completed visit.
Any concerns related to safety or well-being will be handled in accordance with the emergency protocol outlined above.
Client Responsibilities
The client or responsible party agrees to:
Provide accurate and up-to-date information
Maintain a safe environment for visits
Communicate any changes that may impact visits
Safety & Environment
A safe and appropriate environment is required for all visits.
Peace of Mind Care Visits reserves the right to modify or discontinue a visit if conditions are deemed unsafe or inappropriate.
The client or responsible party agrees to communicate any known risks or changes in the environment that may impact visit safety.
Documentation & Photos
For the purpose of documentation and communication, brief notes are maintained following each visit.
If necessary, photos of the environment may be taken to document observations or concerns and may be shared with the designated contact.
A general photo of the individual may be taken periodically for documentation and reference, with the understanding that these images are used solely for internal use and communication with authorized contacts.
Photos are not used for marketing or public purposes without separate, explicit consent.
Acknowledgment
By proceeding with services, you acknowledge and agree to the structure and scope outlined above.
If you have any questions at any time, please don’t hesitate to reach out.