Client Handbook E-Sign

Partners In Care LLC — Electronic handbook acknowledgment for home visits

Client Information

Client Full Name

Client Address

County

Service Line

Staff Name

Handbook Version

Handbook Acknowledgment

I acknowledge that I have received and reviewed the Partners In Care LLC Client Handbook. I understand the policies, procedures, client rights, and responsibilities described in the handbook. I have had the opportunity to ask questions and understand the information provided. By signing below, I acknowledge receipt of this handbook.

I have read and understand the handbook acknowledgment above

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Have the client sign below using their finger or a stylus.

Sign here with your finger or stylus

Printed Name *

Date *

Date

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