Skip to content
Care Services
Personal Care
In-Home Care
Companion Care
Active Living Care
Resources
Community HealthChoices
About Us
Careers
Service Agreement
Employees
My Account
Call (412) 365-4343
Service Agreement
Client/Patient Information
Patient’s First Name
Patient’s Last Name
Patient’s Address
Patient’s City, State, Zip Code
Patient’s Date of Birth
Phone
Emergency/POA Contact Information
First Name
Last Name
Phone
Email
BIA Homecare Service Agreement
This Homecare Service Agreement (“Agreement”) is made between client/power or attorney (information above) and BIA Homecare Services LLC. 1. SERVICES PROVIDED The Homecare Provider agrees to provide the following services to the Client: – Personal care assistance (e.g., bathing, dressing, grooming) – Medication reminders – Meal preparation and feeding assistance – Light housekeeping and laundry – Companionship and emotional support – Healthy Engagement/Mental Stimulation – Mobility assistance and transportation – Other services as agreed upon 2. COMPENSATION – Hourly Rate: The rate shall be as agreed upon in writing via email between BIA Homecare Services LLC and the Client. – Non-Standard Care Rate: If non-standard care is needed (additional services beyond the ones listed above or non-standard hours), a custom hourly rate will be agreed upon in writing via email. – Payment Terms: Credit Card is the only form of payment. Your credit card will be charged every Friday for the upcoming week. – BIA Work Weeks: Sunday through Saturday – Minimum Charge: The minimum charge per week will be 4 hours. – Cancellation Refunds: If BIA Homecare is unable to staff due to illness/emergency or if the Client cancels within 48 hours, a credit for the unused time will be applied to a future payment. 3. TERM, TERMINATION, AND CANCELLATION POLICY – This Agreement shall remain in effect until terminated by either party. – Either party may terminate this Agreement with seven (7) days’ written notice. – If the Client terminates services, they must provide seven (7) days advance notice to allow reassignment of the caregiver. – If the termination is due to the death of the client, the agreement and payments shall cease immediately. – If there is an existing balance for unused services, those funds shall be refunded to the payer. – If there is a balance due, it will be processed immediate. – Immediate termination is allowed for breach of contract, safety concerns, or legal violations. 4. LIABILITY AND INDEMNIFICATION The undersigned fully understands that the provider: (a) is a non-medical provider (b) is not licensed to perform medical services (c) the undersigned indemnifies, jointly and severally, and hereby forever releases, discharges, acquits, and forgives any and all claims, actions, suits, demands, liabilities, judgments, and proceedings both at law and in equity, arising from the beginning of time to the date of termination of this agreement with the BIA Homecare Services. – This release shall be binding upon the insured to benefit the parties, their successors, assigns, and personal representatives. 5. CONFIDENTIALITY Both parties agree to maintain the confidentiality of all personal and medical information shared during the provision of services. 6. GOVERNING LAW This Agreement shall be governed by and interpreted in accordance with the laws of the State of Pennsylvania. 7. PIRATING CLAUSE – Hiring or employing a caregiver outside of this agreement is strictly prohibited. – Violation of this clause results in a $10,000 penalty payable to BIA Homecare Services LLC. – Legal action will be taken for breaches of this clause. 8. DIRECT HIRING CLAUSE If the Client desires to hire the agency caregiver directly, the Client must: – Provide seven (7) days written notice to the agency. – Pay a referral fee equal to two (2) months’ pay or two (2) months’ service contract. – Non-payment within seven (7) working days will result in legal action. 9. ATTORNEY’S FEES If any litigation arises, the prevailing party (BIA Homecare Services LLC) shall recover all legal costs and attorney’s fees. 10. AGREEMENT SIGNATURES By signing below, you agree to the terms and conditions outlined in this Agreement.
Signature
signature
keyboard
Clear
Submit
If you are human, leave this field blank.