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DVA HHS SERVICE SET UP FORM

DVA HHS SERVICE SET UP FORM

Welcome to AkinCare! We are grateful to assist with your DVA Household Services (HHS). To set up your service and allow us to bill DVA directly, please complete this quick form. You will need your DVA Determination Letter and HHS Flyer handy. Once you have them, click Start!
8Questions
  • 1
    Please enter your basic info to create a billing profile with AkinCare. Certain information is required for us to be able to bill DVA directly and any information entered is handled in accordance with out privacy policy. On all paperwork we will use your full name as found on your DVA determination letter, but if you have a preferred name, feel free to enter it in this section.
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    • Male
    • Female
    • Non-Binary
    • Other/Prefer to self Identify
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  • 2
    Please enter your service address. So where would you like the HHS services delivered?
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    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • CuraƧao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • United States
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
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  • 3
    We try our best to work with you to find a day and time that works best with your schedule.
    Please Select
    • Please Select
    • Monday
    • Tuesday
    • Wednesday
    • Thursday
    • Friday
    • No Preference/Flexible
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    • Please Select
    • AM- Before 12pm
    • PM - After 12pm
    • No Preference/Flexible
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  • 4
    Please use the calendar below to select your preferred start date. If you are ready to get started right away, simply choose today's date. If you need a little more time or wish to delay your care for any reason, just pick the future date that works best for you. Please note that while this gives us a great target to aim for.
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    Pick a Date
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  • 5
    Please share anything that will help our team access your home easily and provide the best possible support. This could include property access instructions, pets in the yard or home, including their breeds and names, or recent changes to your health or mobility
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  • 6
    To ensure your experience with us is as seamless as possible, we kindly request a copy of your DVA determination letter. Having this document on file allows us to bill the Department of Veterans' Affairs directly on your behalf, saving you from out-of-pocket costs and claim paperwork. Importantly, it also allows us to verify your specific approved entitlements and the exact frequency of services you are eligible to receive, ensuring we can provide your care completely in line with your DVA coverage. An example of your determination letter can be found here.
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    Max. file size: 10.6MB
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  • 7
    In addition to your determination letter, we also ask that you provide a copy of your HHS flyer. This document contains a unique reference number specific to your approved care. As your provider, we are required to use this exact number to submit our claims directly to DVA on your behalf. Having this flyer on file ensures there are no delays or hiccups in our billing process, allowing us to keep your services completely hassle-free for you. An example of a HHS Flyer can be found here.
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    Max. file size: 10.6MB
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  • 8
    Please review the statement below and confirm your acceptance
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