NURSE FOR A DAY CONCIERGE NURSING AGREEMENT
Business Name:
Nurse For A Day LLC
Email:
Info@yournurseforaday.com
CLIENT INFORMATION
Client Name:
Date of Birth:
-
Month
-
Day
Year
Date
Address:
Phone:
Format: (000) 000-0000.
Email:
example@example.com
Emergency Contact:
Phone:
Format: (000) 000-0000.
SCOPE OF SERVICES
Nurse For A Day provides professional, private, non-emergency nursing services. Services may include but are not limited to: medication management and pillbox setup, basic wound care and dressing changes, post-surgical recovery and monitoring, injections (as prescribed), simple home care assistance, and appointment coordination and scheduling support. All services are performed by a licensed registered nurse in accordance with professional nursing standards and client consent.
SERVICE PACKAGES AND PAYMENT TERMS
Package Options:
3-Hour Package
6-Hour Package
8-Hour Package
A La Carte / Hourly Services:
Available for additional time beyond package hours or for individual services upon client request.
PAYMENT POLICY
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A 50% retainer is required at the time of booking to reserve your appointment. If the appointment is canceled within seven (7) days of the scheduled date, the retainer is forfeited. The remaining balance is due 72 hours prior to the procedure or service date.
LIABILITY AND ACKNOWLEDGMENT
The client acknowledges that Nurse For A Day provides non-emergency concierge nursing services intended for comfort, recovery assistance, and personal support. These services do not replace hospital care, medical emergency treatment, or ongoing primary medical supervision.
EMERGENCY POLICY
In the event of an emergency, the client or their representative should call 911 or seek immediate emergency care.
INSURANCE AND CONFIDENTIALITY
Nurse For A Day is a fully insured professional nursing service. All client health and personal information will be treated with strict confidentiality.
CONSENT AND SIGNATURES
By signing below, the client acknowledges understanding and agreement to the terms outlined in this Concierge Nursing Agreement and consents to receive the described services from Nurse For A Day.
Client Signature:
Printed Name:
Nurse Signature:
Printed Name:
Date:
-
Month
-
Day
Year
Date
Thank you for choosing Nurse For A Day LLC
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