Adult Care

Private Residence Adult Request for Service Order Form

Contact Information

Care Schedule

Travel Care Information

Upon completing the request for service form, FCO will confirm the request for service, email the confirmation with profile attached and charge the credit card provided.  Please note: There are no refunds for cancellations received less than 48 hours prior to the start time of the confirmed services.

Billing:

The rate of service is determined and provided to the client directly upon receiving the request for service. All services are billed in hourly increments, kindly be advised there is a 5-hour minimum charge for all sitting service requests. Upon confirming the care scheduled in this said confirmation, the services will be charged to the credit card provided according to the schedule stated in the email confirmation to follow. In the event the client and/or guest has additional services rendered past the said schedule confirmed, the client and/or guest will be billed a second charge to the original charge.

Transportation Policy: Client is responsible for caregiver's round trip transportation.

Cancellation Policy:

If cancellation is not received by the agency within 24 hours of the start time of reservation the client will be charged for the entire confirmed reservation.

Please Note: Family Care Options holds the right to change the confirmed staff and/ or sitter and/or caregiver without notice in the event Family Care Options receives good information such as but not limited to the current health status of the confirmed staff personnel in which case, Family Care Options will make the necessary change of staff n the best interest of the client according to the original request.

Please note:

Submitting this request for service form it’s considered an order form. For information about our rates and policies, please contact our office before submitting this request.

By signing below, I agree and understand the terms, billing and policy stated above.

I hereby authorize Family Care Options,Inc. by filling out and signing this credit card authorization form to charge the Credit Card provided for any and all services rendered and/or ordered by Family Care Options staff. The credit card provided will be charged in such a manner as if I were paying in person and signing a transaction slip. I understand there will be a 4% service fee for all telephone and internet credit card orders.