By completing this service order form and signing the credit card authorization, I authorize Family Care Options, Inc. to charge the credit card provided for all services rendered. I understand that a 4% service fee applies to telephone and online transactions.
Billing & Rates: Service rates are available on our website and upon request. All services are billed in hourly increments, with a 5-hour minimum for adult care and a $65 surcharge fee if the caregiver works before 8:00 AM and/or past 6:00 PM. Upon confirming the care and schedule stated in this order form, a confirmation will be emailed confirming the services, and any additional services beyond the confirmed schedule will be charged accordingly. Holiday Rates Vary, on all holidays and holiday weekends.
Hotel Adult Care: Starting at $96.00 per hour minimum 5 hours - up to 1 adult
Early Morning & Evening Surcharge: A $65.00 surcharge fee applies before 8:00 AM and/or after 6:00PM. Rate may vary on all holidays and holiday weekends.
Travel Surcharge: Services provided outside the New York Metropolitan Area are subject to a round-trip travel surcharge. The surcharge varies based on the destination.
Same-Day Bookings:
Reservations made less than 24 hours before the requested start time are subject to a $50.00 same-day booking fee.
A $100.00 same day surcharge applies for services on all holidays and holiday weekends.
Cancellation Policy:
Cancellations received less than 48 hours before the scheduled start time, the client will be responsible and billed for the entire schedule of services confirmed. All hourly rates and transportation fees will be charged to the credit card provided.
Cancellations received more than 48 hours in advance will receive a refund.
Staffing Adjustments: Family Care Options may replace the confirmed caregiver/staff without prior notice if necessary, including but not limited to health-related reasons. Adjustments will be made to ensure the client's needs are met according to the original service order.
Caregiver Safety & Professional Conduct: Family Care Options is committed to maintaining a safe, respectful, and professional environment for all clients and caregivers. Should a caregiver encounter any situation reasonably deemed unsafe, threatening, inappropriate, or compromising to their personal safety or well-being, Family Care Options reserves the right to immediately discontinue services, and the caregiver may leave the premises. Any such incident will be reviewed by management, and appropriate action will be taken. When applicable, reasonable measures will be taken to safeguard any individuals entrusted to the caregiver's care.
Health Disclosure: By signing below, I confirm that I have disclosed all relevant health information regarding the adult(s) receiving care. I understand that failure to provide accurate health details may compromise care quality and release Family Care Options from any and/all liability related to undisclosed conditions.
Toys & Food: Caregivers are not permitted to bring outside toys or food.
Payment & Confirmation: Upon submission, services will be confirmed, and the credit card provided will be charged. All major credit cards are accepted.
For more details, rates or company policies, please call our office at (212) 748-8377 or email service@familycareoption.com before submitting this form.
