Client Inquiry Agreement

Comfort Nest In-Home & Memory Care LLC

By submitting this form, you agree to the following:

1. You understand Comfort Nest provides non-medical home care.
   We do not provide skilled nursing, wound care, therapy, injections, or medical services.
    
2. Information submitted will be used only to determine service eligibility.
   This includes general health concerns, care needs, mobility status, and behavioral considerations.
    
3. Submitting this form does not guarantee acceptance or placement.
   A full assessment and signed service contract are required before services begin.
    
4. You consent to be contacted by phone, email, or text for the purpose of scheduling assessments or discussing your inquiry.
    
5. You confirm you are legally authorized to provide information about the person needing care (yourself, a spouse, parent, guardian, etc.).
    
6. You understand aggressive or unsafe situations may require additional rates or may not be eligible for non-medical services.
    
7. You understand your data is protected but not covered by HIPAA, as we are a non-medical home care company.
   You may call us directly if you prefer not to submit health information online.