United for Strength

Consent for Non-Medical Home Care Services

Client Name: Barabara Simpson

Client DOB: 06/01/2025

Client Address: 2251 Burlington, Detroit, MI 48204

Client Phone Number: (313) 569-1254

1. Purpose of This Agreement

By signing below, the client (or authorized representative) consents to receive non-medical home care services provided by United for Strength, a non-medical home care marketplace and its personnel. These services are designed to assist the client in performing daily living activities and maintaining independence at home.

2. Scope of Services

Services may include, but are not limited to:

• Personal care assistance (e.g., bathing, grooming, dressing, toileting)

• Meal preparation and feeding assistance

• Light housekeeping and laundry

• Companionship and supervision

• Medication reminders (no administration)

• Mobility assistance within the home

Transportation and medical care are not included.

3. Service Schedule and Frequency

Services will be provided on the following schedule unless otherwise agreed upon in writing:

• Start Date: 06/01/2025

• End Date (if applicable): N/A

• Days of Service

• Hours per Visit: 4 or more 

• Estimated Weekly Hours: 20 or more

4. Duration of Services

This agreement remains in effect until terminated by either party in accordance with the Termination Policy outlined in the Full-Service Agreement. Services may be adjusted or modified based on client needs or provider availability, with proper notice given.

5. Rates and Payment Terms

• Hourly Rate: $24 per hour

• Minimum Visit Duration: 4 hours

• Billing Cycle: Daily (An invoice will be issued within 24 hours of each completed service visit).

• Payment Terms: Due Upon Receipt — Payment is due immediately upon receipt of each invoice.

• Accepted Payment Methods: ACH, Check, Venmo

• Late Payments: A late fee of $15 or 5% of the outstanding balance (whichever is greater) may apply to any invoice not paid within 48 hours of delivery. The client is responsible for all charges incurred under this agreement.

6. Client Consent

By signing below, I acknowledge and agree that:

• I have reviewed and understand the scope, frequency, and cost of services described above.

• I authorize United for Strength to provide the agreed-upon non-medical care services at the location listed.

• I understand that these services do not include medical care, medication administration, or transportation.

• I understand that I may modify or terminate services with proper notice, per the terms of the Service Agreement.

🛡️ Office Use Only