Home Care Service Signup Form Template - Graphic Reserve

Effortless Home Care Client Onboarding Starts Here

Online Onboarding + Auto-Generated PDF = Zero Hassle

Simplify Client Onboarding with an Online Fillable Form

This home care client intake form template is perfect for home care agencies and senior caregiving services. It can be fully customized to suit your organization’s needs—whether you provide in-home assistance, personal care, or medical support. With this template, you can:

Home Care Client DIgital Intake Form Template

Our professionally designed home care service signup form makes collecting essential patient information simple and efficient. This customizable intake form is built to meet industry standards and helps streamline the onboarding process for new clients. Once completed, both the applicant and your caregiving company automatically receive a professionally formatted PDF copy, making record-keeping effortless.

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Let’s discuss the customization you need.

Explore the Full Form

Without Filling Everything Out

Fully Customizable

This form is fully customizable to match your exact client intake needs. It allows you to streamline and even automate your entire onboarding process, saving time while improving accuracy and client experience.

Dynamic Form

For the most accurate demonstration, we recommend filling in all form fields. The form is dynamic—certain fields will appear only after specific responses are provided. This conditional logic ensures a streamlined and user-friendly experience for actual users.

PDF Preview

To see how the final PDF will look during the client onboarding process, complete and submit the form as if you were a new client. This allows you to preview exactly how the submitted information will be formatted and delivered.

Intake Form

See exactly what your clients will experience when filling out the intake form. Test all features including save & resume, field validation, and PDF generation.

Save Progress and Resume Later Our intake form includes a "Save as Draft" option, allowing you to pause and continue later. A secure link is sent to your email, so you can finish the form at your own pace—no rush, no pressure.

Preview Mode Easily explore the full structure of the form without needing to enter any data. For demonstration purposes, most fields are currently set as optional, allowing you to view every section freely. In a live setup, required fields can be enforced based on your business needs.

Flexible Pricing Plans

Whether you’re a small agency or a large caregiving company, we have a plan to fit your needs.

Basic Plan

Perfect for small home care agencies getting started

$199 setup cost +

$19

/month

Unlimited Submissions
Full customization + branding
PDF generation
Email support
Daily Backup
Website Security
CDN for WordPress website

Professional Plan

Ideal for growing caregiving companies that require frequent form updates.

$199 setup cost +

$29

/month

Unlimited Submissions
Full customization + branding
On demand form update
Caregiver hiring form
PDF generation
Email support
Daily Backup
Website Security
CDN for WordPress website

Complete Website

For business who looking for modern home care website. View Templates

$599 form & website setup cost +

$29

/Month

Everyting on Professional Plan
We will setup brand new website
Mobile responsive
SEO friendly contents
Website daily backup
Landing Pages
Custom training Videos

FAQ

Find Answers to Common Questions

Can I customize the form fields myself later?

Yes! The form is built using a best-in-class system, which has an easy drag-and-drop interface. You’ll be able to add, remove, or update fields as needed without any coding.

Is this form HIPAA-compliant?

Our system follows strong data privacy and security best practices, including SSL encryption and secure email handling. While it is not officially HIPAA-certified, it is designed to safely collect and transmit sensitive client information.

If your agency requires full HIPAA compliance, we recommend using a HIPAA-compliant hosting provider. We’re happy to install and configure the system on your preferred hosting environment to support your compliance needs.

Do I need any technical skills to use the form

No technical skills needed. We handle the full setup for you, and you’ll receive instructions to manage or edit the form easily through your WordPress dashboard.

Is this form mobile-friendly?

Yes, the form is 100% responsive and optimized for mobile devices, ensuring a smooth experience for users on smartphones, tablets, and desktops.

Can I use this form on multiple websites?

No, this license is valid for a single WordPress installation. If you need it for multiple sites, we can offer a discounted multi-site package—just ask!

What type of customization can we achieve with this form?

Our intake form is fully customizable to fit your agency’s needs. You can add or remove any form fields, show or hide sections conditionally based on user responses, and control the layout and content of the generated PDF.

We can also:

Increase the number of PDF pages to organize specific form data
Customize colors, fonts, spacing, and styling to match your brand
Reorder sections, adjust form logic, and personalize email notifications

Whether it’s a simple tweak or a full redesign, the form can be tailored to your exact workflow.

How does it work? How will you set up the form for me?

Once you subscribe, we’ll send you a welcome email with clear, step-by-step instructions. Don’t worry—we’ll guide you through everything. If you don’t see the email in your inbox, please check your junk or spam folder just in case.

Ready to Simplify Your Client Onboarding?

Get started today and make your home care agency’s intake process stress-free and professional.