$19.00 / month and a $199.00 sign-up fee
See exactly what your clients will experience when filling out the intake form. Test all features including save & resume, field validation, and PDF generation.
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:
Without Filling Everything Out
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.
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.
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.
Simplify your Private Duty Home Care onboarding with this online intake form system. Clients can complete forms digitally, and both parties receive a print-ready PDF instantly. Fully customizable, secure, and easy to integrate—save time, reduce paperwork, and deliver a smooth client experience.
Streamline your home care client onboarding process with this professional, ready-to-use online intake form system. Designed specifically for private duty home care agencies, this solution allows clients to complete their intake forms online with ease while automatically generating a print-ready PDF containing all submitted details.
The system ensures accuracy, saves time, and eliminates paperwork by securely collecting client information, health history, and service preferences—all in one place. Both the agency and the client receive a professional, formatted PDF instantly after submission.
Key features include:
Fully customizable form fields and branding
Conditional logic for dynamic question flow
“Save and Continue Later” functionality
Secure data handling and email delivery
Instant, print-ready PDF generation
Deliver a seamless onboarding experience and elevate your agency’s professionalism with this automated online intake and PDF system—built to simplify your workflow and impress your clients.
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.
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.
Yes, the form is 100% responsive and optimized for mobile devices, ensuring a smooth experience for users on smartphones, tablets, and desktops.
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!
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.
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.
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.
