Cuzima Care LLC - Service Agreement
Agreement Overview:
This Service Agreement is made and entered into as of:
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Month
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Day
Year
Date
Between:
Service Provider:
Address:
Phone:
Email:
Client Name:
*
Client Address:
*
Client Phone:
*
Client Email:
*
Client's Legal Representative (if applicable):
Name
Address:
Phone:
Email:
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Responsibilities of the Service Provider
Cuzima Care LLC agrees to:Provide competent, compassionate, and professional care.Maintain client confidentiality.Communicate regularly with the client or legal representative regarding care.
Responsibilities of the Client
The Client and/or their legal representative agrees to:Provide accurate and complete health and care information.Make timely payments as agreed.Notify Cuzima Care LLC of any schedule or care changes.
Service Terms & Payment
The specific details regarding services provided, scheduling, and payment terms will be outlined in a separate document, which both parties will review and agree upon before services begin.
Confidentiality
All personal, medical, and financial information will be kept confidential in compliance with HIPAA and other applicable laws.
Liability Limitations
Cuzima Care LLC is not liable for injuries or damages unless caused by gross negligence or willful misconduct.
Miscellaneous
Governing Law: This Agreement is governed by the laws of the State of Ohio.Entire Agreement: This document constitutes the full agreement between the parties.Amendments: Any changes must be in writing and signed by both parties.
Signatures
By signing below, the parties agree to the terms outlined above.
Service Provider Representative
First Name
Signature
Date
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Day
Year
Date
Client Name
*
First Name
Last Name
Signature
Date
*
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Month
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Day
Year
Date
Client’s Legal Representative (if applicable)
First Name
Last Name
Signature
Date
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Month
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Day
Year
Date
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Should be Empty: