Home Health Care Service Agreement

Professional Home Health Care Service Agreement Template

Finding reliable, trustworthy home health care is one of the most important decisions families make. Whether you're arranging care for an aging parent, a family member recovering from surgery, or someone with ongoing health needs, having a clear, comprehensive service agreement protects everyone involved.

This Home Health Care Service Agreement template is designed for home healthcare agencies, independent caregivers, and families who want to establish clear expectations from day one. It covers everything from daily caregiver duties and medication management to emergency protocols and schedule modifications—all in one professional, easy-to-complete form.

Why home health care providers need a formal service agreement

Home health care involves trust, responsibility, and often vulnerable individuals. A formal agreement ensures:

• Clear role definitions so caregivers know exactly what's expected
• Emergency protocols documented and accessible when seconds count
• Liability protection for both the care provider and the client
• Transparent scheduling with a process for modifications and cancellations
• Consent and authorization for medical decisions when needed

Without a signed agreement, misunderstandings can lead to disputes, gaps in care, or worse—legal liability. This template helps you establish professional boundaries while building trust with clients and their families.

What's included in this template

This form captures all the essential information for a home health care arrangement:

• Client and caregiver information with emergency contacts
• Detailed care requirements including personal care, medication, mobility assistance and special needs
• Daily duties and responsibilities tailored to the client's situation
• Emergency procedures including medical contacts, hospital preferences, and crisis protocols
• Schedule and availability with flexibility for modifications
• Liability waiver and release protecting caregivers from claims arising from services provided in good faith
• Cancellation and modification policies to manage changes professionally
• Consent for care decisions when family members aren't immediately available

Perfect for home healthcare agencies and independent caregivers

Whether you're running a licensed home health agency, managing a senior care service, or working as an independent caregiver, this template adapts to your needs. It's equally useful for families hiring private caregivers who want to formalize the arrangement professionally.

The form is easy to customize—add your agency branding, adjust the liability language to match your insurance requirements, or modify the duties checklist to reflect your specific service offerings.

Streamline onboarding with Paperform

Using Paperform for your home health care agreements means you can:

• Collect eSignatures through Papersign to make agreements legally binding
• Sync data automatically to your scheduling software, CRM, or care management platform
• Send confirmation emails with care schedules, emergency numbers, and next steps
• Store responses securely with SOC 2 Type II compliance for sensitive health information
• Update forms easily as your services or policies evolve

You can also use Stepper to automate what happens after the form is submitted—send the agreement for signature, create a client record in your database, assign a care coordinator, and trigger an onboarding workflow—all without manual data entry.

Build trust through transparency

Home health care is deeply personal. The right service agreement demonstrates professionalism, protects everyone legally, and sets the foundation for a successful care relationship. With Paperform's flexible form builder, you can create an agreement that feels approachable and human while covering all the legal essentials.

Get started with this template and give families the peace of mind they deserve.