Home Care Client Intake Bundle
An 18-file Word template bundle that takes a USA non-medical home care agency from the first inquiry call to an assessed, signed client file.
Every file is an editable Microsoft Word (.docx) document. This is a Word-only download: no PDF, Excel, or Canva files are included. You can also open the files in Google Docs; some layout may shift slightly there.
What’s included (18 Word files)
- New Potential Client Inquiry (6 pages)
- Client Profile (6 pages)
- Client Rights and Responsibilities (6 pages)
- Client Bill of Rights (5 pages)
- Care Assessment Short Consult (4 pages)
- Home Environment Safety Evaluation (6 pages)
- Fall Risk Assessment Form (5 pages)
- Credit Card Authorization Form (3 pages)
- Transport Waiver Form (4 pages)
- Guided Intake Call Script (6 pages)
- Call Intake Record Inbound Call Tracker (4 pages)
- Home Care Quote (4 pages)
- Home Care Follow-Up Letter (4 pages)
- Client Intake Form (5 pages)
- Care Assessment Report (5 pages)
- Caregiving Service Fee Information Sheet (4 pages)
- Home Care Assessment (14 pages)
- Home Care Service Agreement (8 pages)
Page counts include an agency instructions page in most files, to delete before use. Forms and trackers are blank and ready to fill. Trackers are printable Word trackers, not spreadsheets or software.
How it works
- Purchase and instantly download one ZIP file with all 18 Word documents.
- Open each file in Microsoft Word or Google Docs.
- Replace the logo placeholder and agency name, address, and contact line with your own.
- Edit any wording, delete the instructions page, and save, print, or use digitally.
Please note
- This is a digital download.
- These are customizable templates, not legal advice, and are not a license to operate, HIPAA software, or a guarantee of compliance with any law or regulation. They make no medical claims.
- State rules vary. Check your state’s requirements, and have your own counsel review agreements and policies before use.
- The service agreement, client rights documents, transport waiver, and card authorization form are starting points only: have your counsel review them, and check your state’s rules before use. Rates and fees in the service agreement are left blank for you to fill in. The assessments are non-medical: they record what the client and family report and what staff observe, not diagnoses.
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