Service Request Form

It Is Time Home Care

Non-Medical Home Services Request Form
This is a non-medical service. We provide errands, grocery shopping, light housekeeping, household organization, companion visits, wellness check-ins, and pickups for independent individuals only.
Who is requesting services?
Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Service Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Client Full Name

First NameLast Name
Client Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Client
Preferred Service Date

MonthDayYear
Date
Preferred Time
Which service(s) are you requesting?
If Other, please describe:
Emergency Contact Information
Emergency Contact Full Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Emergency Contact
If Other, please describe
Please describe the services you are requesting.
Please provide any details that may help us understand your request.
Service Agreement
It Is Time Home Care provides non-medical support services only. We do not provide medical care, medication administration, bathing assistance, lifting, transferring, transportation, supervision, or other hands-on healthcare services. Service requests are subject to review and approval and are not guaranteed until confirmed.
I have read, understand, and agree to the Service Agreement.
Payment and Cancellation Policy
Payment may be required before services are provided. Cancellations should be made at least 2 hours before the scheduled service time. Late cancellations or no-shows may result in a service fee.
I have read, understand, and agree to the Payment and Cancellation Policy.
PRIVACY POLICY
PRIVACY POLICY

Effective Date: June 2026

It Is Time Home Care respects your privacy and is committed to protecting the personal information you provide.

Information We Collect

We may collect information you voluntarily provide, including:

• Name

• Phone Number

• Email Address

• Service Address

• Service Requests and Related Information

How We Use Information

Information submitted through our website, contact forms, email communications, or service requests may be used to:

• Respond to inquiries

• Schedule and provide services

• Process payments

• Communicate regarding requested services

• Maintain business records

Information Sharing

It Is Time Home Care does not sell, rent, or trade personal information to third parties.

Information may be shared when required by law or when necessary to provide requested services.

Data Security

Reasonable measures are taken to protect personal information from unauthorized access, disclosure, or misuse.

Third-Party Services

Our website may use third-party providers such as payment processors, website hosting providers, form providers, and email services. These providers maintain their own privacy policies.

Your Rights

You may contact us to request updates or corrections to the information you have provided.

Contact Us

If you have questions regarding this Privacy Policy, please contact:

It Is Time Home Care

Email: service@itistimehomecare.com

© 2026 It Is Time Home Care™

A division of It Is Time Group LLC
I have read, understand, and agree to the Privacy Policy.
Should be Empty:

It Is Time Home Care

Emergency Contact Information

Service Agreement

Payment and Cancellation Policy

PRIVACY POLICY