Home Care Admin Experts Intake Form
Please fill out the information below and provide as many details as possible to be able to provide you with an accurate quote on all our home care solutions.
If you have any questions regarding our solutions, please refer to our Client Handbook
or speak with your designated representative. All information relayed on this form will remain private.
Do you have experience operating remotely/virtually? Who handles your after hours service inquiries if a potential client calls?
MATCHING YOU WITH THE BEST EXPERT FOR YOUR NEEDS IS IMPORTANT. BE PATIENT WE ARE ALMOST DONE!
Which Scheduling Software do you utilize? KEY PERFORMANCE INDICATORS
How long has your most senior caregiver been with you?
How long has your most senior office staff member been with you?
How many new hires do you hire per week:
How many new clients do you start per week?
How many caregivers do you terminate per week?
How long has your office been open?
When Calling Your Office Do you have a prompt for each department?
Estimate Number of Calls Per Day During Business Hours
Estimate Number of Calls Per Week When Office is closed and CALL offs
ORIENTATION AND RECRUITING
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On a Scale from 1-10, Rate your Caregiver's Accountability:
Do you have experience recruiting virtually?
Are your caregivers trained on electronically clocking in and out?
Describe your orientation process in detail if interesting in recruiting services:
Do you accept Text Messages from Clients and Caregivers to Communicate After hours?
Do you allow NON-emergency calls after hours?
Do you allow NON-emergency calls after hours?
Are you opposed to informing caregivers to minimize contacy for any reason other than a change in client condition, fall, or 911 inspired emergencies from 12am-6am?
ON-CALL PHONE NUMBER:
We will provide you with a phone number to forward all your calls to during business hours. Please provide the AREA code you would like us to use if we are providing ON-CALL SERVICES. An additional charge on service is a charge per number at $47.00 per month.
RECRUITING NUMBER:
Recruiting Services are conducted during business hours from our private recruiting line, and we do not require a new number for Recruiting Services.
SCHEDULING AND VIRTUAL ASSISTANCE (DURING BUSINESS HOURS) :
Remote Daytime Schedule Or VA Services: During Business Hours only; If we are scheduling for your company- We will use YOUR VOIP system and will be making calls as if from office and as if in office.
Which VoIP system do you currently utilize? (We recommend RingCentral or Unite)
CONFIDENTIALITY NOTICE: This information/email/sheet, including all attachments, is for the sole use of the intended recipient(s) and may contain confidential information. Any unauthorized review, use, disclosure, alteration, or distribution is strictly prohibited and may violate state or federal law.
Request a Quote
Thanks! We’ll send you a qoute within 24-48 hours after an initial consultation.