AllCare Living Services, Inc. is hereby authorized by the client and/or their guardian to provide services for the above named client. The client and/or their guardian recognize they have retained the right to refuse or terminate services. In addition, agency also has the right to terminate services by notifying the client and/or their guardian of termination and the reason. AllCare Living Services, Inc. employees on assignment are hereby authorized to provide such services as they are qualified to and/or obtain any medical services as they deem required in the event of a medical emergency. The client and/or their guardian agree to assume sole responsibility for any and all charges for transportation, treatment, etc., and any other related expenses incurred by the agency or the client. The client and/or their guardian hereby authorize the release and request that copies of the client’s necessary medical records be delivered to AllCare Living Services, Inc. to establish and continue services. The client and/or their guardian also authorize the agency to release copies of patient records, reports, etc. as may be relevant to aid other health care providers in the client’s care.

AllCare Living Services, Inc. provides services that may involve granting its employees a certain amount of access to the home and personal property of the clients and/or their guardians. Although the agency undertakes reasonable efforts to screen and hire employees that exhibit the ability and integrity to properly perform the services on behalf of the agency, clients and/or their guardians are solely responsible under this agreement to secure all valuables including items in their home such as jewelry, cash, credit cards, cash/debit cards or any other items of value. The client and/or their guardian shall not request any of the agency’s employees handle any financial affairs, jewelry, cash, or other items of value. The client and/or their guardian shall notify the agency immediately of any discrepancies that may be related to the employees providing services. Agency employees are not allowed to accept gifts, loans, or any other items of value on behalf of the client and/or their guardian. In the event the client and/or their guardian fails to observe the requirements and/or procedures set forth in this section, the client and/or the guardian shall indemnify and hold harmless the agency, its officers, and employees against any and all claims, losses, damages, expenses, or liability arising from any action of the agency’s employees with respect to the property, valuables and/or cash of the client and any other occupants in the home.

I understand and agree that AllCare Living Services, Inc. does not provide insurance coverage and is not responsible for, under any circumstances, for any injuries I might incur, damages to my automobile or other property resulting from the use of my automobile by AllCare’s employees, regardless of fault. I agree to notify AllCare, in advance, and I understand that I must receive written authorization from AllCare, before any AllCare employee may operate my automobile or transport me in an AllCare employee’s automobile. I hereby release AllCare Living Services, Inc. and its employees assigned to me, and hold AllCare and it’s employees harmless and indemnify them from any claim, liability, or cause of action of personal injuries (including death) or for property damages resulting from the use of an automobile (whether or not owned by me) if operated by an AllCare employee, whether or not prior written authorization from AllCare has been obtained.

Concierge services are paid for in advance for a flat fee of ninety-nine dollars ($99) and includes up to four (4) hours of caregiver services and transportation up to twenty (20) miles each way. If services exceed the allotted time or if transportation exceeds the allotted distance, the client is responsible for all additional charges. Additional services will be provided for $27 per hour and $.65 per mile.